Publication:

Use of tranexamic acid in primary hip arthroplasty: a retrospective audit of blood loss and transfusion rates

Background Tranexamic acid (TXA) is an anti-fibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported the significance of blood loss reduction and the reduction in the number of blood transfusions, thereby reducing transfusion- related injuries and enhancing patient recovery. The concern about the use of tranexamic acid is the venous thromboembolic effect it may possess. We aimed to study the efficacy and safety of this anti-fibrinolytic medication in primary total hip arthroplasty.

Methods We conducted a retrospective chart review of 130 primary total hip arthroplasty (THA) performed from June 2023 to June 2025 at a single arthroplasty centre in South Korea by a single renowned arthroplasty surgeon. Surgical patients received 1 g intra-venous (IV) TXA half hour before the surgery followed by 2g intra-articular (IA) TXA during the surgery through a hemobag line. We analysed differences in haemoglobin (Hb), haematocrit (Hct), blood loss (BL), and adverse events in these patients.

Results The mean age was 61.3 years, and the mean BMI was 21.5 kg/m². All patients received 3g TXA. The mean blood loss was 550 ml, and mean hemoglobin drop after surgery was 1.13 g/dl. Strong positive correlation was found between blood loss and transfusions (r=0.726, p<0.001). Twenty-one adverse events were reported.

Conclusions Administration combined intravenous (IV) and intra-articular (IA) TXA does not appear to increase rates of adverse events and may be effective in minimizing blood loss, thereby minimizing the number of blood transfusions as reflected by Hb and Hct values following THA.