Efficacy of Tranexamic Acid on Perioperative Blood Loss in Hip Arthroplasty: A Comparative Study
-
Shantanu Vijay
,
Subham Verma
,
Bharat Soni
,
Tarun Desai
,
Prashant Alwani
,
Jeevan Kishor Appala
,
Chirag Valentine Thakkar
Abstract
Background: Using tranexamic acid (TXA) as a measure to ensure hemostasis during surgeries involving the hip region is a topic
that is still debated, with scarce literature. The aim of this study was to assess the effectiveness of TXA administration in improving
outcomes of hip arthroplasty.
Methods: This is a randomized comparative prospective study. It was conducted in the Department of Orthopedics, GMERS Medical
College and Hospital, Vadodara, India, from January 2023 to December 2023 on 60 patients undergoing hip arthroplasty.
Results: The postoperative mean hemoglobin (Hb) value after 24 hours in the test group was 10.9 ± 1.6 g/dl while it was 10.1 ± 1.4 in
the control group, which was statistically significant. The mean duration of surgery in the test group was 102.7 ± 28.2 minutes versus
125.2 ± 36.5 minutes in control with a P-value of 0.01, indicating less surgical duration in the test group.
Conclusion: TXA is an effective agent to reduce intraoperative blood loss, reduce surgical time, and improve post-operative Hb levels.
1.
Sculco PK, McLawhorn AS, Fehring KA, De Martino I. The future
48
of social media in orthopedic surgery. Curr Rev Musculoskelet
Med. 2017;10(2):278-9. doi: 10.1007/s12178-017-9412-9. [PubMed:
28456946]. [PubMed Central: PMC5435643].
2.
3.
Theusinger OM, Kind SL, Seifert B, Borgeat L, Gerber C, Spahn
DR. Patient blood management in orthopaedic surgery: a four
year follow-up of transfusion requirements and blood loss
from 2008 to 2011 at the Balgrist University Hospital in Zurich,
Switzerland.
Blood Transfus. 2014;12(2):195-203. doi:
10.2450/2014.0306-13. [PubMed: 24931841]. [PubMed Central:
PMC4039701].
Sizer SC, Cherian JJ, Elmallah RD, Pierce TP, Beaver WB, Mont
MA. Predicting Blood Loss in Total Knee and Hip Arthroplasty.
Orthop
Clin
North
Am. 2015;46(4):445-59.
10.1016/j.ocl.2015.06.002. [PubMed: 26410634].
doi:
4. Mikhail C, Pennington Z, Arnold PM, Brodke DS, Chapman JR,
Chutkan N, et al. Minimizing Blood Loss in Spine Surgery. Global
Spine J. 2020;10(1 Suppl):71s-83s. doi: 10.1177/2192568219868475.
[PubMed: 31934525]. [PubMed Central: PMC6947684].
5.
Lee JH, Han SB. Patient Blood Management in Hip
Replacement Arthroplasty. Hip Pelvis. 2015;27(4):201-8. doi:
10.5371/hp.2015.27.4.201. [PubMed: 27536627]. [PubMed Central:
PMC4972790].
6. Carling MS, Jeppsson A, Eriksson BI, Brisby H. Transfusions and
blood loss in total hip and knee arthroplasty: a prospective
observational study. J Orthop Surg Res. 2015;10:48. doi:
10.1186/s13018-015-0188-6.
[PubMed: 25889413]. [PubMed
Central: PMC4383080].
7.
Miao K, Ni S, Zhou X, Xu N, Sun R, Zhuang C, et al. Hidden
blood loss and its influential factors after total hip
arthroplasty. J Orthop Surg Res. 2015;10:36. doi: 10.1186/s13018
015-0185-9.
[PubMed:
PMC4367912].
25889223].
[PubMed
Central:
8. Cohn MR, Levack AE, Trivedi NN, Villa JC, Wellman DS, Lyden JP,
et al. The Hip Fracture Patient on Warfarin: Evaluating Blood
Loss and Time to Surgery. J Orthop Trauma. 2017;31(8):407-13.
doi: 10.1097/bot.0000000000000857. [PubMed: 28445186].
9. Nielson E, Hennrikus E, Lehman E, Mets B. Angiotensin axis
blockade, hypotension, and acute kidney injury in elective
major orthopedic surgery. J Hosp Med. 2014;9(5):283-8. doi:
10.1002/jhm.2155. [PubMed: 24464761].
10. Lerman DM, Rapp TB. Minimizing Blood Loss in Orthopaedic
Surgery The Role of Antifibrinolytics. Bull Hosp Jt Dis (2013).
2015;73(2):83-9. [PubMed: 26517160].
11.
Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of
Tranexamic Acid in Orthopedic Surgery. Orthopedics.
2016;39(2):119-30. doi: 10.3928/01477447-20160301-05. [PubMed:
26942474].
12. Danninger T, Memtsoudis SG. Tranexamic acid and orthopedic
surgery-the search for the holy grail of blood conservation.
Ann Transl Med. 2015;3(6):77. doi: 10.3978/j.issn.2305
5839.2015.01.25. [PubMed: 25992376]. [PubMed Central:
PMC4416949].
13. Thorsen S, Clemmensen I, Sottrup-Jensen L, Magnusson S.
Adsorption to fibrin of native fragments of known primary
structure from human plasminogen. Biochim Biophys Acta.
1981;668(3):377-87. doi: 10.1016/0005-2795(81)90171-9. [PubMed:
7236714].
14. Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, et al.
Reduction of blood loss using tranexamic acid in total knee
and hip arthroplasties. Arch Orthop Trauma Surg.
2000;120(9):518-20. doi: 10.1007/s004029900132. [PubMed:
11011672].
15. Katsaros D, Petricevic M, Snow NJ, Woodhall DD, Van Bergen R.
Tranexamic acid reduces postbypass blood use: a double
blinded, prospective, randomized study of 210 patients. Ann
Thorac Surg. 1996;61(4):1131-5. doi: 10.1016/0003-4975(96)00022
7. [PubMed: 8607670].
16. Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use
in the management of menorrhagia. Drugs. 2003;63(13):
1417-33. doi: 10.2165/00003495-200363130-00008. [PubMed:
12825966].
17. Gianakos AL, Hurley ET, Haring RS, Yoon RS, Liporace FA.
Reduction of Blood Loss by Tranexamic Acid Following Total
Hip and Knee Arthroplasty: A Meta-Analysis. JBJS Rev.
2018;6(5):e1. doi: 10.2106/jbjs.Rvw.17.00103. [PubMed: 29738409].
18. Moskal JT, Capps SG. Meta-analysis of Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty. Orthopedics.
2016;39(5):e883-92.
doi:
[PubMed: 27248332].
10.3928/01477447-20160526-02.
19. Inacio MC, Ake CF, Paxton EW, Khatod M, Wang C, Gross TP, et
al. Sex and risk of hip implant failure: assessing total hip
arthroplasty outcomes in the United States. JAMA Intern Med.
2013;173(6):435-41.
doi:
[PubMed: 23420484].
10.1001/jamainternmed.2013.3271.
20. Basques BA, Bell JA, Fillingham YA, Khan JM, Della Valle CJ.
Gender Differences for Hip and Knee Arthroplasty:
Complications and Healthcare Utilization. J Arthroplasty.
2019;34(8):1593-7.e1. doi: 10.1016/j.arth.2019.03.064. [PubMed:
31003781].
21. Gandhi R, Evans HM, Mahomed SR, Mahomed NN. Tranexamic
acid and the reduction of blood loss in total knee and hip
arthroplasty: a meta-analysis. BMC Res Notes. 2013;6:184. doi:
10.1186/1756-0500-6-184. [PubMed: 23651507]. [PubMed Central:
PMC3655041].
22. Wang C, Xu GJ, Han Z, Ma JX, Ma XL, Jiang X, et al. Topical
application of tranexamic acid in primary total hip
arthroplasty: A systemic review and meta-analysis. Int J Surg.
2015;15:134-9. doi: 10.1016/j.ijsu.2014.12.023. [PubMed: 25576011].
23. Haratian A, Shelby T, Hasan LK, Bolia IK, Weber AE, Petrigliano
FA. Utilization of Tranexamic Acid in Surgical Orthopaedic
Practice: Indications and Current Considerations. Orthop Res
Rev. 2021;13:187-99. doi: 10.2147/orr.S321881. [PubMed: 34703327].
J Orthop Spine Trauma. 2025; 11(2): 45-9.
[PubMed Central: PMC8541761].
24. Chen S, Wu K, Kong G, Feng W, Deng Z, Wang H. The efficacy of
topical tranexamic acid in total hip arthroplasty: a meta
analysis. BMC Musculoskelet Disord. 2016;17:81. doi:
10.1186/s12891-016-0923-0.
[PubMed: 26878845]. [PubMed
Central: PMC4754977].
25. Peck J, Kepecs DM, Mei B, Safir OA, Backstein D, Gross AE, et al.
The Effect of Preoperative Administration of Intravenous
Tranexamic Acid During Revision Hip Arthroplasty: A
Retrospective Study. J Bone Joint Surg Am. 2018;100(17):1509-16.
doi: 10.2106/jbjs.17.01212. [PubMed: 30180060].
26. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid
on transfusion rate in primary total hip arthroplasty. J
Arthroplasty. 2014;29(2):387-9. doi: 10.1016/j.arth.2013.05.026.
[PubMed: 23790499].
27. Kayupov E, Fillingham YA, Okroj K, Plummer DR, Moric M,
Gerlinger TL, et al. Oral and Intravenous Tranexamic Acid Are
Equivalent at Reducing Blood Loss Following Total Hip
Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg
Am. 2017;99(5):373-8. doi: 10.2106/jbjs.16.00188. [PubMed:
28244907].
28. Haynes JA, Stambough JB, Sassoon AA, Johnson SR, Clohisy JC,
Nunley RM. Contemporary Surgical Indications and Referral
Trends in Revision Total Hip Arthroplasty: A 10-Year Review. J
Arthroplasty. 2016;31(3):622-5. doi: 10.1016/j.arth.2015.09.026.
[PubMed: 26541220].
Sculco PK, McLawhorn AS, Fehring KA, De Martino I. The future
48
of social media in orthopedic surgery. Curr Rev Musculoskelet
Med. 2017;10(2):278-9. doi: 10.1007/s12178-017-9412-9. [PubMed:
28456946]. [PubMed Central: PMC5435643].
2.
3.
Theusinger OM, Kind SL, Seifert B, Borgeat L, Gerber C, Spahn
DR. Patient blood management in orthopaedic surgery: a four
year follow-up of transfusion requirements and blood loss
from 2008 to 2011 at the Balgrist University Hospital in Zurich,
Switzerland.
Blood Transfus. 2014;12(2):195-203. doi:
10.2450/2014.0306-13. [PubMed: 24931841]. [PubMed Central:
PMC4039701].
Sizer SC, Cherian JJ, Elmallah RD, Pierce TP, Beaver WB, Mont
MA. Predicting Blood Loss in Total Knee and Hip Arthroplasty.
Orthop
Clin
North
Am. 2015;46(4):445-59.
10.1016/j.ocl.2015.06.002. [PubMed: 26410634].
doi:
4. Mikhail C, Pennington Z, Arnold PM, Brodke DS, Chapman JR,
Chutkan N, et al. Minimizing Blood Loss in Spine Surgery. Global
Spine J. 2020;10(1 Suppl):71s-83s. doi: 10.1177/2192568219868475.
[PubMed: 31934525]. [PubMed Central: PMC6947684].
5.
Lee JH, Han SB. Patient Blood Management in Hip
Replacement Arthroplasty. Hip Pelvis. 2015;27(4):201-8. doi:
10.5371/hp.2015.27.4.201. [PubMed: 27536627]. [PubMed Central:
PMC4972790].
6. Carling MS, Jeppsson A, Eriksson BI, Brisby H. Transfusions and
blood loss in total hip and knee arthroplasty: a prospective
observational study. J Orthop Surg Res. 2015;10:48. doi:
10.1186/s13018-015-0188-6.
[PubMed: 25889413]. [PubMed
Central: PMC4383080].
7.
Miao K, Ni S, Zhou X, Xu N, Sun R, Zhuang C, et al. Hidden
blood loss and its influential factors after total hip
arthroplasty. J Orthop Surg Res. 2015;10:36. doi: 10.1186/s13018
015-0185-9.
[PubMed:
PMC4367912].
25889223].
[PubMed
Central:
8. Cohn MR, Levack AE, Trivedi NN, Villa JC, Wellman DS, Lyden JP,
et al. The Hip Fracture Patient on Warfarin: Evaluating Blood
Loss and Time to Surgery. J Orthop Trauma. 2017;31(8):407-13.
doi: 10.1097/bot.0000000000000857. [PubMed: 28445186].
9. Nielson E, Hennrikus E, Lehman E, Mets B. Angiotensin axis
blockade, hypotension, and acute kidney injury in elective
major orthopedic surgery. J Hosp Med. 2014;9(5):283-8. doi:
10.1002/jhm.2155. [PubMed: 24464761].
10. Lerman DM, Rapp TB. Minimizing Blood Loss in Orthopaedic
Surgery The Role of Antifibrinolytics. Bull Hosp Jt Dis (2013).
2015;73(2):83-9. [PubMed: 26517160].
11.
Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of
Tranexamic Acid in Orthopedic Surgery. Orthopedics.
2016;39(2):119-30. doi: 10.3928/01477447-20160301-05. [PubMed:
26942474].
12. Danninger T, Memtsoudis SG. Tranexamic acid and orthopedic
surgery-the search for the holy grail of blood conservation.
Ann Transl Med. 2015;3(6):77. doi: 10.3978/j.issn.2305
5839.2015.01.25. [PubMed: 25992376]. [PubMed Central:
PMC4416949].
13. Thorsen S, Clemmensen I, Sottrup-Jensen L, Magnusson S.
Adsorption to fibrin of native fragments of known primary
structure from human plasminogen. Biochim Biophys Acta.
1981;668(3):377-87. doi: 10.1016/0005-2795(81)90171-9. [PubMed:
7236714].
14. Ido K, Neo M, Asada Y, Kondo K, Morita T, Sakamoto T, et al.
Reduction of blood loss using tranexamic acid in total knee
and hip arthroplasties. Arch Orthop Trauma Surg.
2000;120(9):518-20. doi: 10.1007/s004029900132. [PubMed:
11011672].
15. Katsaros D, Petricevic M, Snow NJ, Woodhall DD, Van Bergen R.
Tranexamic acid reduces postbypass blood use: a double
blinded, prospective, randomized study of 210 patients. Ann
Thorac Surg. 1996;61(4):1131-5. doi: 10.1016/0003-4975(96)00022
7. [PubMed: 8607670].
16. Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use
in the management of menorrhagia. Drugs. 2003;63(13):
1417-33. doi: 10.2165/00003495-200363130-00008. [PubMed:
12825966].
17. Gianakos AL, Hurley ET, Haring RS, Yoon RS, Liporace FA.
Reduction of Blood Loss by Tranexamic Acid Following Total
Hip and Knee Arthroplasty: A Meta-Analysis. JBJS Rev.
2018;6(5):e1. doi: 10.2106/jbjs.Rvw.17.00103. [PubMed: 29738409].
18. Moskal JT, Capps SG. Meta-analysis of Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty. Orthopedics.
2016;39(5):e883-92.
doi:
[PubMed: 27248332].
10.3928/01477447-20160526-02.
19. Inacio MC, Ake CF, Paxton EW, Khatod M, Wang C, Gross TP, et
al. Sex and risk of hip implant failure: assessing total hip
arthroplasty outcomes in the United States. JAMA Intern Med.
2013;173(6):435-41.
doi:
[PubMed: 23420484].
10.1001/jamainternmed.2013.3271.
20. Basques BA, Bell JA, Fillingham YA, Khan JM, Della Valle CJ.
Gender Differences for Hip and Knee Arthroplasty:
Complications and Healthcare Utilization. J Arthroplasty.
2019;34(8):1593-7.e1. doi: 10.1016/j.arth.2019.03.064. [PubMed:
31003781].
21. Gandhi R, Evans HM, Mahomed SR, Mahomed NN. Tranexamic
acid and the reduction of blood loss in total knee and hip
arthroplasty: a meta-analysis. BMC Res Notes. 2013;6:184. doi:
10.1186/1756-0500-6-184. [PubMed: 23651507]. [PubMed Central:
PMC3655041].
22. Wang C, Xu GJ, Han Z, Ma JX, Ma XL, Jiang X, et al. Topical
application of tranexamic acid in primary total hip
arthroplasty: A systemic review and meta-analysis. Int J Surg.
2015;15:134-9. doi: 10.1016/j.ijsu.2014.12.023. [PubMed: 25576011].
23. Haratian A, Shelby T, Hasan LK, Bolia IK, Weber AE, Petrigliano
FA. Utilization of Tranexamic Acid in Surgical Orthopaedic
Practice: Indications and Current Considerations. Orthop Res
Rev. 2021;13:187-99. doi: 10.2147/orr.S321881. [PubMed: 34703327].
J Orthop Spine Trauma. 2025; 11(2): 45-9.
[PubMed Central: PMC8541761].
24. Chen S, Wu K, Kong G, Feng W, Deng Z, Wang H. The efficacy of
topical tranexamic acid in total hip arthroplasty: a meta
analysis. BMC Musculoskelet Disord. 2016;17:81. doi:
10.1186/s12891-016-0923-0.
[PubMed: 26878845]. [PubMed
Central: PMC4754977].
25. Peck J, Kepecs DM, Mei B, Safir OA, Backstein D, Gross AE, et al.
The Effect of Preoperative Administration of Intravenous
Tranexamic Acid During Revision Hip Arthroplasty: A
Retrospective Study. J Bone Joint Surg Am. 2018;100(17):1509-16.
doi: 10.2106/jbjs.17.01212. [PubMed: 30180060].
26. Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid
on transfusion rate in primary total hip arthroplasty. J
Arthroplasty. 2014;29(2):387-9. doi: 10.1016/j.arth.2013.05.026.
[PubMed: 23790499].
27. Kayupov E, Fillingham YA, Okroj K, Plummer DR, Moric M,
Gerlinger TL, et al. Oral and Intravenous Tranexamic Acid Are
Equivalent at Reducing Blood Loss Following Total Hip
Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg
Am. 2017;99(5):373-8. doi: 10.2106/jbjs.16.00188. [PubMed:
28244907].
28. Haynes JA, Stambough JB, Sassoon AA, Johnson SR, Clohisy JC,
Nunley RM. Contemporary Surgical Indications and Referral
Trends in Revision Total Hip Arthroplasty: A 10-Year Review. J
Arthroplasty. 2016;31(3):622-5. doi: 10.1016/j.arth.2015.09.026.
[PubMed: 26541220].
| Files | ||
| Issue | Vol 11 No 2 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i2.18880 | |
| Keywords | ||
| Total Hip Arthroplasty Hip Hemiarthroplasty Tranexamic acid | ||
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How to Cite
1.
Vijay S, Verma S, Soni B, Desai T, Alwani P, Appala J, Thakkar C. Efficacy of Tranexamic Acid on Perioperative Blood Loss in Hip Arthroplasty: A Comparative Study. J Orthop Spine Trauma. 2025;11(2):45-9.
