title: Tranexamic acid versus fibrin sealant in primary total hip replacement: a comparative study.
abstract: BACKGROUND
  The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group.
  
  
  METHODS
  We prospectively studied 273 patients with primary hip osteoarthritis who underwent a THR between February 2012 and September 2013. The first 73 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray, and the last 100 patients received 1 g TA on induction.
  
  
  RESULTS
  The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the three groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 and 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0 vs. 10%, p = 0.05). There was no significant difference between the groups with regard to proportion of patients with wound leaking problems.
  
  
  CONCLUSIONS
  Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.
authors.affiliation: Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK. Aatifm@gmail.com.
authors.forename: Aatif
authors.identifier: http://orcid.org/0000-0002-5879-6529
authors.initials: A
authors.lastname: Mahmood
authors.affiliation: Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
authors.forename: Seif
authors.initials: S
authors.lastname: Sawalha
authors.affiliation: Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
authors.forename: Aaron
authors.initials: A
authors.lastname: Borbora
authors.affiliation: Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
authors.forename: Gunasekaran
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Royal Liverpool and Broadgree University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK.
authors.forename: Viju
authors.initials: V
authors.lastname: Peter
mesh_terms: D000336:Aerosols; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000008:administration & dosage*; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D000336:Aerosols; D000933:Antifibrinolytic Agents; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives; D014148:Tranexamic Acid
keywords: Blood loss; Fibrin sealant; Total hip replacement; Tranexamic acid