Effects of Two Different Administration Methods of Tranexamic Acid on Perioperative Blood Loss During Total Hip Arthroplasty: a Prospective, Open-label, Randomized, Controlled Clinical Trial

Background Total hip arthroplasty (THA) is extensively used in various hip diseases. Abundant blood supply at surgical area of bone tissue, intraoperative extensive cleaning, acetabular formation, femoral expansion, and medullary cavity and bone wound bleeding, will lead to extensive intraoperative and postoperative blood loss. The blood transfusion rate is high, which affects patients' rehabilitation. Previous studies have shown that 16%-69% patients required blood transfusion after first THA, which greatly affected patient's rehabilitation, and increased the risk of transfusion-related infection, hemolysis, immunosuppression, acute lung injury, and death. How to reduce perioperative blood loss in total hip arthroplasty has become a hot spot for joint surgeons.

Tranexamic acid as a synthetic antifibrinolytic drug is a synthetic analog of the amino acid lysine. Its mechanisms of action are the competitive inhibition of fibrinolytic zymogens, and noncompetitive inhibition of fibrinolytic enzymes. Tranexamic acid strongly inhibits plasmin-induced fibrin decomposition, reduces fibrinolytic system activity, to achieve local hemostasis and reduce bleeding (Appendix 1). However, the route of administration of tranexamic acid is diverse, and the best way to administer is not clear. A large number of studies have confirmed that during total knee arthroplasty and THA, intravenous application of tranexamic acid can significantly reduce postoperative blood loss, blood transfusion volume and blood transfusion rate. Intra-articular application of tranexamic acid can reduce the drainage volume of drainage tube, total blood loss, blood transfusion volume and blood transfusion rate after joint arthroplasty. Moreover, hemoglobin levels remarkably increase after surgery. More and more studies and meta-analysis have verified that tranexamic acid has a "target effect". Reasonable use of tranexamic acid does not increase the risk of deep venous thrombosis or pulmonary embolism after hip and knee arthroplasties. Simultaneously, tranexamic acid has a good potency ratio.

Adverse events

1. To record adverse events during follow up, including incision pain, infection, hip pain, peripheral nerve injury, pulmonary embolism, lower extremity hematoma, deep vein thrombosis, and fixator falling off.
2. If severe adverse events occur, investigators would report details, including the date of occurrence and measures taken to treat the adverse events, to the principle investigator and the institutional review board within 24 hours.

Data collection, management, analysis, open access