Public HealthReducing Blood Loss After THR
Post-operative anaemia is a recognised complication of total hip replacement and can increase the length of hospital stay, delay rehabilitation and is poorly tolerated by patients with vascular disease. Current practice sees homologous blood transfusion commonly used to correct blood loss, however, it is associated with risk of infection, viral transmission, fluid overload and high cost. Thus various blood-conserving techniques are also used to reduce the need for homologous blood transfusion, of these fibrinolytic inhibitors, such as tranexamic acid have been shown to be cost-effective in reducing blood loss in surgery.
However, the efficacy of tranexamic acid in THR remains uncertain and therefore this study investigated the effect of a standardised intravenous bolus dose of 1g of tranexamic acid, given at the induction of anaesthesia in patients undergoing THR and tested the potential prothrombotic effect by undertaking routine venography. In all, 36 patients received 1g of tranexamic acid and 37 no tranexamic acid, with blood loss measured directly per-operatively and indirectly post-operatively.
The tranexamic acid group required fewer transfusions and had no increased incidence of deep-vein thrombosis. The tranexamic acid was shown to reduce both early post-operative blood loss and total blood loss, but not the intra-operative blood loss. The reduction in early post-operative blood loss was more marked in women and this result was dose related. Therefore, the authors conclude that "the administration of a standardised pre-operative 1g of tranexamic acid was cost-effective in reducing the blood loss and transfusion requirements after total hip replacement, especially in women".
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The Journal of Bone and Joint Surgery