Combination Of Intravenous And Topical Application Of Tranexamic Acid In Primary Total Hip Arthroplasty

Background:Total hip arthroplasty(THA)is associated with considerable blood loss and the need for blood transfusions.Several studies have shown the effectiveness of intravenous(IV)or topical administration of tranexamic acid(TXA)in reducing postoperative blood loss in THA.However,there are few studies on the combination of IV and topical application of TXA in primary THA.The purpose of this study was to evaluate the effect of combined preoperative IV and topical administration of TXA in THA.Methods:Between April 2014 and March 2015,a total of 231 patients were randomized into three groups:74 patients received a preoperative IV injection of 2 g TXA(IV-TXA group),78 patients received a preoperative IV injection of 2 g TXA and a topical application of 2 g TXA(combined-TXA group),and 79 patients received a topical application of 2 g TXA(topical-TXA group).Total blood loss,total volume of drainage and transfusion rates were recorded.Postoperative deep vein thrombosis and other complications were also noted.Results:The mean total blood loss was lower in the combined-TXAgroup(652.4±212.3 m L)than in the IV-TXA(827.9±296.8 m L)ortopical-TXA(894.7±363.6 m L)groups(P<0.001).Transfusion rates and the postoperative mean total volume of drainage were significantly less in the combined-TXA group than in the other 2 groups.There were no significant differences in postoperative deep vein thrombosis or other complications among the groups.Conclusion:The combination of IVand topical application of TXA is more effective for reducing total blood loss,transfusion rates and total volume of drainage compared to IV or topical application of TXA alone in primary THA and is not associated with an increase in thromboembolic complications.