ROLE OF TRANEXAMIC ACID IN CONTROLLING BLOOD LOSS IN TOTAL HIP ARTHROPLASTY
DOI:
https://doi.org/10.22159/ijcpr.2024v16i5.5075Keywords:
Intravenous, Topical, Total hip arthroplasty, Tranexamic acid, Blood lossAbstract
Objective: The incidence of total hip arthroplasty (THA) is on the rise, often resulting in significant blood loss. It has been observed that Tranexamic acid (TXA) can diminish the blood loss experienced during the perioperative period of hip joint arthroplasty. Nonetheless, the optimal method of administering TXA remains a topic of debate. So, we studied the role of Tranexamic Acid in Controlling Blood Loss in Total Hip Arthroplasty.
Methods: In Prospective group data: By giving a dose of 15 mg/kg of Tranexamic acid, intravenously 15 min before given incision and 15 mg/kg topically after the closure of the hip joint capsule. Retrospective data from the records of previous patients who were administered intravenous tranexamic acid while undergoing THR in the past 3 years with 30 cases in each group. Information was gathered regarding the volume of blood loss, levels of hemoglobin, frequency of transfusions, and the incidence of deep vein thrombosis and pulmonary embolism.
Results: The mean operation times were approximately 43.5±9.0 min and 42.2±8.0 min in group A and group B, respectively. The operation time and intra-operative blood loss show insignificant differences in prospective and retrospective groups. The post-operative blood loss, total blood loss, and decrease in haemoglobin level depicted insignificant differences in prospective and retrospective groups. There were insignificant differences in terms of blood loss and systemic complications between tranexamic acid administration methods.
Conclusion: Tranexamic acid is effective in minimizing blood loss following surgery as well as the overall blood loss associated with total hip arthroplasty, according to the data reviewed and the results of this study showing non-inferior efficacy of topical TXA and IV TXA with IV TXA, we proposed that topical administration of 15 mg/ml of TXA before wound closure was a simple, safe, feasible and effective prophylactic measure with minimal adverse effects. The use of this method proved to be economical, effectively decreasing bleeding, diminishing the necessity for additional blood transfusions, and averting the possibility of surgical intervention due to excessive bleeding.
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References
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-5. doi: 10.2106/JBJS.F.00222, PMID 17403800.
Saleh A, Small T, Chandran Pillai AL, Schiltz NK, Klika AK, Barsoum WK. Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample 2000 to 2009. J Bone Joint Surg Am. 2014 Sep 17;96(18):e155. doi: 10.2106/JBJS.M.00825, PMID 25232085.
Newman ET, Watters TS, Lewis JS, Jennings JM, Wellman SS, Attarian DE. Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty. J Bone Joint Surg Am. 2014 Feb 19;96(4):279-84. doi: 10.2106/JBJS.L.01041, PMID 24553883.
Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J. Intravenous versus topical tranexamic acid in primary total hip replacement: a meta-analysis. Med (Baltim). 2016 Dec;95(50):e5573. doi: 10.1097/MD.0000000000005573, PMID 27977590.
Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg. 2010 Mar;18(3):132-8. doi: 10.5435/00124635-201003000-00002, PMID 20190103.
Ngichabe S, Obura T, Stones W. Intravenous tranexamic acid as an adjunct haemostat to ornipressin during open myomectomy. a randomized, double-blind placebo-controlled trial. Ann Surg Innov Res. 2015 Oct 31;9:10. doi: 10.1186/s13022-015-0017-y, PMID 26568770.
Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J. 2014 Aug;96-B(8):1005-15. doi: 10.1302/0301-620X.96B8.33745, PMID 25086114.
Chen S, Wu K, Kong G, Feng W, Deng Z, Wang H. The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2016 Feb 16;17:81. doi: 10.1186/s12891-016-0923-0, PMID 26878845.
North WT, Mehran N, Davis JJ, Silverton CD, Weir RM, Laker MW. Topical vs intravenous tranexamic acid in primary total hip arthroplasty: a double-blind randomized controlled trial. J Arthroplasty. 2016 May;31(5):1022-6. doi: 10.1016/j.arth.2015.11.003, PMID 26703193.
Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2014 Aug;29(8):1528-31. doi: 10.1016/j.arth.2014.03.011, PMID 24768543.
Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res. 2014 Jan-Apr;8(1):48-53. doi: 10.4103/0259-1162.128908, PMID 25886103.
Jansen AJ, Andreica S, Claeys M, D Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999 Oct;83(4):596-601. doi: 10.1093/bja/83.4.596, PMID 10673876.
Heyns M, Knight P, Steve AK, Yeung JK. A single preoperative dose of tranexamic acid reduces perioperative blood loss: a meta-analysis. Ann Surg. 2021 Jan 1;273(1):75-81. doi: 10.1097/SLA.0000000000003793, PMID 32224739.
Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015;2015(6):CD007872. doi: 10.1002/14651858.CD007872.pub3, PMID 26079202.
Teoh WY, Tan TG, Ng KT, Ong KX, Chan XL, Hung Tsan SE. Prophylactic topical tranexamic acid versus placebo in surgical patients: a systematic review and meta-analysis. Ann Surg. 2021 Apr 1;273(4):676-83. doi: 10.1097/SLA.0000000000003896, PMID 32282377.
Lohani KR, Kumar C, Kataria K, Srivastava A, Ranjan P, Dhar A. Role of tranexamic acid in axillary lymph node dissection in breast cancer patients. Breast J. 2020 Jul;26(7):1316-20. doi: 10.1111/tbj.13810, PMID 32172534.
Ueno M, Sonohata M, Fukumori N, Kawano S, Kitajima M, Mawatari M. Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty. J Orthop Sci. 2016;21(1):44-7. doi: 10.1016/j.jos.2015.10.011, PMID 26755385.
Wei W, Wei B. Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty. J Arthroplasty. 2014 Nov;29(11):2113-6. doi: 10.1016/j.arth.2014.07.019, PMID 25155138.
Teoh WY, Tan TG, Ng KT, Ong KX, Chan XL, Hung Tsan SE. Prophylactic topical tranexamic acid versus placebo in surgical patients: a systematic review and meta-analysis. Ann Surg. 2021 Apr 1;273(4):676-83. doi: 10.1097/SLA.0000000000003896, PMID 32282377.
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Copyright (c) 2024 MANISH S. CHAUHAN, SYED T. MAHMOOD, GAUTAM CHATERJII, MANMOHAN SHAKYA, VISHNU PAL, P. V. SIDDHARTHA
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