Can combined intra-articular and intra-venous tranexamic acid administration further reduce blood loss in total hip arthroplasty? A prospective randomised controlled trial comparing combined versus intravenous administration

Abstract

Introduction: Intravenous (IV) or Intra-articular (IA) administration of tranexamic acid (TXA) showed to reduce blood loss in total hip arthroplasty (THA). Aim of study is to evaluate combined IV and IA administration of TXA in reduction of blood loss when compared with IV only administration. Methodology: In this IRB approved study, patients, undergoing unilateral THA, were randomized into 2 groups: (1) IV TXA only: pre-operative IV TXA (15 mg/kg) on induction, and same dose given 4hrs afterwards. (2) Combined IV & IA TXA : 3gm of TXA applied topically in additional to the IV TXA in regimen (1). All patients received standardized perioperative care. Trial participants and care providers were blinded to study. Primary outcomes included haemoglobin drop, blood loss calculated by Gross formula, volume of drain output, and transfusion rate. Secondary outcomes included venous thromboembolism, and rehabilitation parameters. Results and Analysis: A total of 28 patients (Mean age: 60.5±13.4 ; Male : Female = 16:12). Perioperative parameters were comparable between groups. Group 2 had lower calculate blood loss at postop D0 (355.9 ±274.3, 249.1±106.7ml, p=0.039), but not in postop D1-D2. There was no statistically significant difference in haemoglobin drop from postop D0 to D2 (D0 : 2.39±1.14, 2.17±0.96 g/dL, p=0.47), and volume of drain output (104.3±93.2, 120.8±159.1 ml, p=0.207) between groups. No patients required blood transfusion, or were complicated by venous thromboembolism. The rehabilitation outcomes were comparable between groups. Discussion and Conclusion: Combined TXA administration only showed transient reduction in blood loss at D0 when compared with IV only.