Combined use of intraarticular and intravenous tranexamic acid in total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2016.48.001

Abstract

Abstract:

BACKGROUND: Tranexamic acid has been shown to block the binding between fibrin containing lysine residues and fibrinolytic enzyme, to impede the decomposition of fibrin and to achieve the effect of hemostasis.

OBJECTIVE: To assess the efficacy and safety of tranexamic acid in reducing the perioperative blood loss during the primary total hip arthroplasty by intravenous and intraarticular injection.

METHODS: Sixty-five patients undergoing total hip arthroplasty were randomly assigned to two groups: intravenous and intraarticular injection group (combination group; n=31) and intravenous injection group (n=34). In the combination group, 15 mgkg tranexamic acid was intravenously injected at 30 minutes before replacement. 50 mL of tranexamic acid 1 g was intraarticularly given in the articular capsule after suturing the articular capsule during replacement. In the intravenous injection group, 1 g tranexamic acid was intravenously injected before replacement. 50 mL of physiological saline was intraarticularly given in the articular capsule after suturing the articular capsule during replacement. On day 2 after replacement, drainage tube was pulled out and recorded. On days 1 and 3 after replacement, coagulation, hematocrit and hemoglobin were reviewed. At 1 week after replacement, venous ultrasound examination of the lower extremities was conducted. The perioperative amount of blood transfusion was recorded in both groups. The total amount of perioperative blood loss was calculated by the Gross equation.

RESULTS AND CONCLUSION: (1) The postoperative drainage, the cases of blood transfusion and the theoretical blood loss of the combination group were significantly less than in the intravenous injection group (P < 0.05). (2) Hemoglobin and hematocrit were significantly higher in the combination group than in the intravenous injection group on days 1 and 3 (P < 0.05). (3) There were no significant differences between the two groups in postoperative coagulation function, thromboembolic events, septum thrombosis or deep thromboembolic events (P > 0.05). (4) These findings suggested that combined use of intraarticular 15 mg/kg and intravenous tranexamic acid 1 g is an effective method to reduce the postoperative blood loss in total hip arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Hip, Tranexamic Acid, Deep Vein Thrombosis, Pulmonary Embolism, Tissue Engineering

CLC Number:

R318

Sun Shi-wei, Yang Long, Xie Shui-an, Wang Jian, Xu Ru-bin. Combined use of intraarticular and intravenous tranexamic acid in total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(48): 7149-7155.

Figures/Tables 2

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