Tranexamic acid reduces blood loss in total hip replacement surgery

Intraoperatively administered, tranexamic acid (TA) does not reduce bleedin g in total hip replacement (THR). Therefore, its prophylactic use was attem pted in the present study because this has been shown to be more effective in cardiac surgery. We investigated 40 patients undergoing THR in a prospec tive, randomized, double-blinded study. Twenty patients received TA given i n two bolus doses of 10 mg/kg each, the first just before surgical incision and the second 3 h later. In addition, a continuous infusion of TA, 1.0 mg . kg(-1) . h(-1) for 10 h, was given after the first bolus dose. The remai ning 20 patients formed a control group. Both groups used preoperative auto logous blood donation and intraoperative autotransfusion. Intraoperative bl eeding was significantly less (P = 0.001) in the TA group compared with the control group (630 +/- 220 mL vs 850 +/- 260 mL). Postoperative drainage b leeding was correspondingly less (P = 0.001) (520 +/- 280 vs 920 +/- 410 mL ). Up to 10 h postoperatively, plasma D-dimer concentration was halved in t he TA group compared with the control group. One patient in each group had an ultrasound-verified late deep vein thrombosis. In conclusion, we found T A, administrated before surgical incision, to be efficient in reducing blee ding during THR.