Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Abstract Background To investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture. Methods From our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression. Results A total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05). Conclusion Hypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion. Level of evidence Level III, retrospective study.

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Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

The Journal of Knee Surgery ◽

10.1055/s-0037-1606376 ◽

2017 ◽

Vol 31 (07) ◽

pp. 654-663 ◽

Cited By ~ 7

Author(s):

Wen-Li Dai ◽

Ai-Guo Zhou ◽

Hua Zhang ◽

Jian Zhang

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Total Blood Loss ◽

Transfusion Rate ◽

Thromboembolic Complications ◽

Total Blood ◽

Total Knee ◽

Primary Total Knee

AbstractThe use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate (p = 0.75), total blood loss (p = 0.51), total drain output (p = 0.60), maximum hemoglobin drop (p = 0.24), length of stay (p = 0.08), and thromboembolic complications (p = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.

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Effect of tranexamic acid use on blood loss and thromboembolic risk in hip fracture surgery: systematic review and meta-analysis

Hip International ◽

10.5301/hipint.5000556 ◽

2017 ◽

Vol 28 (1) ◽

pp. 3-10 ◽

Cited By ~ 6

Author(s):

Dinnish Baskaran ◽

Syed Rahman ◽

Yousuf Salmasi ◽

Saied Froghi ◽

Onur Berber ◽

...

Keyword(s):

Hip Fracture ◽

Blood Transfusion ◽

Blood Loss ◽

Meta Analysis ◽

Total Blood Loss ◽

Allogenic Blood Transfusion ◽

Total Blood ◽

Allogenic Blood ◽

Transfusion Requirements ◽

Duration Of Surgery

Introduction: Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence. Methods: A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events. Results: 8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00001), reduced operative blood loss of 88.5 mls (95% CI, 59.9-117.2; p<0.00001), a decrease in the need for allogenic blood transfusion (OR 0.37; 95% CI, 0.26-0.53; p<0.00001) and a reduction in pre- and postoperative haemoglobin difference (p = 0.013.) There was no significant increase in VTE risk (OR 1.59; 95% CI 0.67-3.75; p>0.29) or significant difference on duration of surgery seen with IV TXA usage (p>0.06). Conclusions: Our review demonstrated the efficacy of IV TXA in minimising perioperative, reducing total blood loss and lowering the necessity for allogenic blood transfusions with no significant increased risk in VTE events.

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The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02512-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jimin Ma ◽

Hanli Lu ◽

Xinxing Chen ◽

Dasai Wang ◽

Qiang Wang

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Meta Analysis ◽

Total Blood Loss ◽

Wound Complications ◽

Transfusion Rate ◽

Tibial Osteotomy ◽

Thromboembolic Events ◽

Efficacy And Safety ◽

Total Blood

Abstract Objective The present meta-analysis was conducted to evaluate the efficacy and safety of the application of tranexamic acid (TXA) in patients undergoing high tibial osteotomy (HTO). Methods PubMed (MEDLINE), EMBASE, and Cochrane Library were systematically searched for relevant literature from inception until 1 February 2021. A combined searching strategy of subject words and random words was adopted. After testing for potential publication bias and/or heterogeneity, we aggregated variables by using the random-effect model. The primary comparison outcome measures were total blood loss, hemoglobin decrease, drain output, wound complications, thrombotic events, and blood transfusion rate of the TXA group versus control. The meta-analysis was performed using the RevMan 5.3 software. Results A total of 5 studies were included involving 532 patients. The results showed that there were significant differences in the two groups concerning total blood loss (95% confidence interval [CI] − 332.74 to − 146.46, P < 0.00001), hemoglobin decrease on postoperative day (POD) 1, 2, and 5 (POD 1 95% CI − 1.34 to − 0.63, P < 0.00001; POD 2 95% CI − 1.07 to − 0.68, P < 0.00001; POD 5 95% CI − 1.46 to − 0.84, P < 0.00001), drain output (POD total 95% CI − 195.86 to − 69.41, P < 0.00001) and wound complications (RR = 0.34, 95% CI 0.12 to 0.97, P = 0.04). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 0.46, 95% CI 0.09 to 2.41, P = 0.36) and blood transfusion rate (RR = 0.25, 95% CI 0.03 to 2.27, P = 0.22). Conclusions This meta-analysis of the available evidence demonstrated that TXA could reduce total blood loss, hemoglobin decrease, drain output, and wound complications without increasing the incidence of thromboembolic events in patients undergoing HTO. But there is no obvious evidence that TXA could reduce blood transfusion rates. Further studies, including more large-scale and well-designed randomized controlled trials, are warranted to assess the efficacy and safety issues of routine TXA use in HTO patients.

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Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02363-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yong Hu ◽

Min-Cong Wang ◽

Tao Wang ◽

Yue Meng ◽

Xiao-Min Chao ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Total Blood Loss ◽

Transfusion Rate ◽

Operative Blood Loss ◽

Total Blood ◽

Radiographic Findings ◽

Total Hip ◽

Affected Side

Abstract Background Although excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH). Methods This retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss. Results Two hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group. Conclusion SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.

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Dynamic Analysis of Perioperative Hidden Blood Loss in Intertrochanteric Fractures

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618823279 ◽

2019 ◽

Vol 25 ◽

pp. 107602961882327 ◽

Cited By ~ 2

Author(s):

Shuwei Tian ◽

Hui Li ◽

Meiyu Liu ◽

Yanlong Zhang ◽

Aqin Peng

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Intertrochanteric Fracture ◽

Complete Blood Count ◽

Dynamic Changes ◽

Total Blood ◽

Hidden Blood Loss ◽

Postoperative Drainage ◽

Males And Females ◽

Perioperative Blood Transfusion

To analyze the dynamic variation in perioperative hidden blood loss in patients with intertrochanteric fracture. From January to December 2017, 79 patients with intertrochanteric fracture were treated with proximal femoral nail antirotation. Serial complete blood count assays were performed consecutively in the 3 days after admission, on the day of surgery, and 7 days postoperatively. Blood loss during surgery, postoperative drainage, and perioperative blood transfusion volumes were recorded. Dynamic changes in hemoglobin (Hb) prior to surgery were recorded and compared between males and females. Patients were divided into the no blood transfusion group, the 400-mL blood transfusion group, and the 800-mL blood transfusion group depending on the volume of perioperative blood transfusion. Total and hidden blood loss were separately calculated according to the Gross equation. Lowest mean Hb values occurred on day 2 after admission among men (104.8 g/L) and on day 3 after admission among women (98.6 g/L). The average Hb decrease was 11.4 g/L, 11.8 g/L, and 8.9 g/L in the no, 400-mL, and 800-mL blood transfusion groups, respectively. The lowest Hb value occurred on postoperative day 2. Hemoglobin increased on postoperative day 3 and stabilized by day 6. In the no blood transfusion group, the average total blood loss was 406.0 ± 255.6 mL, 628.3 ± 267.2 mL, and 759.7 ± 322.1 mL in the no blood transfusion, 400-mL blood transfusion, and 800-mL blood transfusion groups, respectively, and hidden blood loss was 326.0 ± 246.6 mL, 512.1 ± 247.3 mL, and 596.1 ± 306.9 mL, respectively. Perioperative hidden blood loss occurred prior to surgery for intertrochanteric fracture and ended on postoperative day 2.

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Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2018-024350 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024350 ◽

Cited By ~ 13

Author(s):

Qi Sun ◽

Jinyu Li ◽

Jiang Chen ◽

Chenying Zheng ◽

Chuyin Liu ◽

...

Keyword(s):

Blood Loss ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Total Blood Loss ◽

Controlled Trials ◽

Transfusion Rate ◽

Total Blood ◽

Total Knee ◽

Randomised Controlled ◽

Blood Loss Volume

ObjectiveThis study aimed to compare the effects of intravenous, topical and combined routes of tranexamic acid (TXA) administration on blood loss and transfusion requirements in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).DesignThis was a meta-analysis of randomised controlled trials (RCT) wherein the weighted mean difference (WMD) and relative risk (RR) were used for data synthesis applied in the random effects model. Stratified analyses based on the surgery type, region, intravenous and topical TXA dose and transfusion protocol were also conducted. The main outcomes included intraoperative and total blood loss volume, transfusion rate, low postoperative haemoglobin (Hb) level and postoperative Hb decline. However, the secondary outcomes included length of hospital stay (LOS) and/or occurrence of venous thromboembolism (VTE).SettingWe searched the PubMed, Embase and Cochrane CENTRAL databases for RCTs that compared different routes of TXA administration.ParticipantsPatients undergoing TKA or THA.InterventionsIntravenous, topical or combined intravenous and topical TXA.ResultsTwenty-six RCTs were selected, and the intravenous route did not differ substantially from the topical route with respect to the total blood loss volume (WMD=30.92, p=0.31), drain blood loss (WMD=−34.53, p=0.50), postoperative Hb levels (WMD=−0.01, p=0.96), Hb decline (WMD=−0.39, p=0.08), LOS (WMD=0.15, p=0.38), transfusion rate (RR=1.08, p=0.75) and VTE occurrence (RR=1.89, p=0.15). Compared with the combined-delivery group, the single-route group had significantly increased total blood loss volume (WMD=198.07, p<0.05), greater Hb decline (WMD=0.56, p<0.05) and higher transfusion rates (RR=2.51, p<0.05). However, no significant difference was noted in the drain blood loss, postoperative Hb levels and VTE events between the two groups. The intravenous and topical routes had comparable efficacy and safety profiles.ConclusionsThe combination of intravenous and topical TXA was relatively more effective in controlling bleeding without increased risk of VTE.

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Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02010-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yimin Zhang ◽

Bao Lang ◽

Guifeng Zhao ◽

Fengming Wang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Study Results ◽

Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

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Comparison Between Bilateral Simultaneous Total Hip Arthroplasty With and Without Drainage; a Retrospective Cohort Study

10.21203/rs.3.rs-625749/v1 ◽

2021 ◽

Author(s):

Min-Gwang Kim ◽

Taek-Rim Yoon ◽

Kyung-Soon Park

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Postoperative Bleeding ◽

Total Blood Loss ◽

Postoperative Blood Loss ◽

Consecutive Series ◽

Transfusion Rate ◽

Total Blood

Abstract BackgroundThere are many reports staged bilateral THA without drainage is a better method than with drainage in many ways. However, there is little report regarding bilateral simultaneous THA (BSTHA) without drainage. This study aimed to evaluate the differences in the clinical outcomes and complication rate of BSTHA with drainage and without drainage.MethodsBetween October 2015 and April 2019, a retrospective cohort study was conducted with modified minimally invasive two-incision method and a consecutive series of 41 BSTHA performed with drainage were compared to 37 BSTHA performed without drainage. It was assessed clinically and radiographically for a mean of 2.1 ± 0.8 years (range, 1.0-4.8 years). Postoperative hematologic values (Hgb drop, Hct drop, total blood loss, transfusion rate), pain susceptibility, functional outcome, and complication were compared in the drained group and the non-drained group. All patients preoperatively received intravenous tranexamic acid (TXA) and intraoperatively received intra-articular TXA on each hip. Statistical analyses were performed using the independent t tests, Chi-squared or Fisher’s exact tests. A significance level of ≤ 0.05 was used for all statistical tests.Results Mean postoperative Hgb (g/dL, p < 0.001) & Hct drop (%, p < 0.001), mean total blood loss (ml, p < 0.001) and mean transfusion unit (IU, p < 0.001) were significantly lower in the BSTHA without drainage than in the BSTHA with drainage group. But the mean dose of morphine equivalent (mg, p < 0.001) was significantly larger in BSTHA without drainage.ConclusionBSTHA without drainage can reduce postoperative blood loss and the requirement for transfusion without increasing other complication. But BSTHA without drainage is more painful method than BSTHA with drainage. Therefore, BSTHA without drainage will be a good option to reduce the burden on the patient by reducing postoperative bleeding if it can control pain well after surgery.

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Single dose of tranexamic acid effectively reduces blood loss and transfusion rates in elderly patients undergoing surgery for hip fracture: a randomized controlled trial

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1288.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 442-448

Author(s):

Vasileios S. Nikolaou ◽

Panagiotis Masouros ◽

Themistoklis Floros ◽

Efstathios Chronopoulos ◽

Maria Skertsou ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Single Dose ◽

Hip Fracture ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Controlled Trial ◽

Total Blood ◽

Subcapital Fracture ◽

Randomized Controlled

Aims The aim of this study was to investigate the hypothesis that a single dose of tranexamic acid (TXA) would reduce blood loss and transfusion rates in elderly patients undergoing surgery for a subcapital or intertrochanteric (IT) fracture of the hip. Methods In this single-centre, randomized controlled trial, elderly patients undergoing surgery for a hip fracture, either hemiarthroplasty for a subcapital fracture or intramedullary nailing for an IT fracture, were screened for inclusion. Patients were randomly allocated to a study group using a sealed envelope. The TXA group consisted of 77 patients, (35 with a subcapital fracture and 42 with an IT fracture), and the control group consisted of 88 patients (29 with a subcapital fracture and 59 with an IT fracture). One dose of 15 mg/kg of intravenous (IV) TXA diluted in 100 ml normal saline (NS,) or one dose of IV placebo 100 ml NS were administered before the incision was made. The haemoglobin (Hb) concentration was measured before surgery and daily until the fourth postoperative day. The primary outcomes were the total blood loss and the rate of transfusion from the time of surgery to the fourth postoperative day. Results Homogeneity with respect to baseline characteristics was ensured between groups. The mean total blood loss was significantly lower in patients who received TXA (902.4 ml (-279.9 to 2,156.9) vs 1,226.3 ml (-269.7 to 3,429.7); p = 0.003), while the likelihood of requiring a transfusion of at least one unit of red blood cells was reduced by 22%. Subgroup analysis showed that these differences were larger in patients who had an IT fracture compared with those who had a subcapital fracture. Conclusion Elderly patients who undergo intramedullary nailing for an IT fracture can benefit from a single dose of 15 mg/kg TXA before the onset of surgery. A similar tendency was identified in patients undergoing hemiarthroplasty for a subcapital fracture but not to a statistically significant level. Cite this article: Bone Joint J 2021;103-B(3):442–448.

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Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10153272 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3272

Author(s):

Man-Soo Kim ◽

In-Jun Koh ◽

Yong-Gyu Sung ◽

Dong-Chul Park ◽

Won-Jun Ha ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

High Tibial Osteotomy ◽

Total Blood Loss ◽

Wound Complications ◽

Control Group ◽

Transfusion Rate ◽

Tibial Osteotomy ◽

Total Blood ◽

Wedge High Tibial Osteotomy

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

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