A comparative study on hemostasis effect of different application methods and time of tranexamic acid in total hip arthroplasty

Objectives To analyze the hemostatic effect of different application methods and time of tranexamic acid (TXA) on primary unilateral total hip arthroplasty.Methods A total of 126 patients with primary unilateral total hip replacement admitted between January 2019 and January 2021 were recruited. The patients were divided into three groups (42 people in each group) by random number table method. In group I, 2.0 g TXA was perfused locally into the hip joint cavity through the drainage tube for 2 h. Group II was perfused locally with the same method for 4 h. Group III was given TXA 15 mg/kg intravenously 5-10 min before surgical incision. The hemoglobin concentration, red blood cell (RBC) count, international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D), intraoperative blood loss, postoperative blood loss, implicit blood loss, total blood loss, postoperative blood transfusion and complications were compared.Results The postoperative drainage volume of group I (195.07 +/- 34.65) mL and group II (199.62 +/- 38.07) mL was significantly lower than that of group III (213.12 +/- 25.05) mL (P = 0.037). There was no significant difference in postoperative drainage between group I and group II (P > 0.05). There was no significant difference in intraoperative blood loss, hidden blood loss and total blood loss between the three groups (P > 0.05). There was no difference in the incidence of deep vein thrombosis among the three groups (P > 0.05).Conclusions TXA is a safe and effective way of hemostasis in total hip arthroplasty. Local intraarticular application of TXA can reduce the postoperative drainage, but the difference is not clinically significant, probably due to the number of samples. There is no difference in the postoperative drainage after local application of 2 or 4 h, and there is no difference in the overall hemostasis effect between intravenous or local application of TXA.