A prospective study to assess the efficacy of tranexamic acid in reducing blood loss during total hip arthroplasty

Background: Tranexamic acid has been reported to reduce bleeding, risk of thromboembolic events and the need for allogenic blood transfusion in total hip replacement patients. The present study was conducted to assess the efficacy of tranexamic acid in reducing blood loss during total hip replacement surgery.Methods: Total hip arthroplasty patients (n=60) were divided into control and test groups with 30 patients each. Test group was administered with tranexamic acid (15 mg/kg) for 15 min before and after the surgery. Patients were administered cefuroxime (1.5 g), 30 min prior to the surgery and deep vein thrombosis prophylaxis; enoxaparin (40 mg), 48 hours after surgery. Demographic details along with levels of hemoglobin and blood loss before, during and after the surgery were recorded.Results: Tranexamic acid reduced the early post-surgical blood loss (292±132.38 vs. 155.8±86.56 ml; p<0.0001), total blood loss (989.6±340.98 vs. 580.4±131.88 ml; p<0.0001), and the blood loss during surgery (723.5±277.73 vs. 434.3±131.83 ml; p<0.05). Test group required fewer transfusions (6.7%) than control group (26%) and had no increased incidence of deep-vein thrombosis. Postsurgical hemoglobin in the control group had significantly reduced as compared to test group.Conclusions: Administration of intravenous tranexamic acid before and after the surgery was effective in reducing the blood loss and transfusion requirements and its related complications.

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Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648020 ◽

1976 ◽

Vol 36 (01) ◽

pp. 157-164 ◽

Cited By ~ 34

Author(s):

P. M Mannucci ◽

Luisa E. Citterio ◽

N Panajotopoulos

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Control Group ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646293 ◽

1992 ◽

Vol 68 (04) ◽

pp. 436-441 ◽

Cited By ~ 23

Author(s):

Nigel E Sharrock ◽

George Go ◽

Robert Mineo ◽

Peter C Harpel

Keyword(s):

Heart Rate ◽

Deep Vein Thrombosis ◽

Cardiac Index ◽

Total Hip Replacement ◽

Epidural Anesthesia ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

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