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Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement : a randomized controlled trial (TRANX-H)
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Alshryda, Sattar, Mason, James, Sarda, Praveen, Nargol, Antoni, Cooke, Nick, Ahmad, Hafeez, Tang, S., Logishetty, Raj, Vaghela, Manesh, McPartlin, Lynne and Hungin, A Pali S. (2013) Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement : a randomized controlled trial (TRANX-H). The Journal of Bone and Joint Surgery, 95 (21). pp. 1969-1974. doi:10.2106/JBJS.L.00908 ISSN 0021-9355.
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Official URL: http://dx.doi.org/http://dx.doi.org/10.2106/JBJS.L...
Abstract
Background: Approximately one-third of patients undergoing total hip replacement surgery require one to three units of blood postoperatively. Tranexamic acid is a synthetic antifibrinolytic agent that has been successfully used intravenously to control bleeding after total hip replacement. A topical application is easy to administer, provides a maximum concentration of tranexamic acid at the bleeding site, and is associated with little or no systemic absorption of the tranexamic acid.
Methods: A double-blind, randomized controlled trial of 161 patients undergoing unilateral primary total hip replacement investigated the effect of topical (intra-articular) application of tranexamic acid on blood loss. The primary outcome was the blood transfusion rate. Secondary outcomes included the drain blood loss, hemoglobin concentration drop, generic quality of life (EuroQol), Oxford Hip Score, length of stay, a cost analysis, and complications.
Results: Tranexamic acid reduced the absolute risk of blood transfusion by 19.6% (95% confidence interval [CI], 6.9% to 32.1%; p = 0.004), from 32.1% to 12.5%, and reduced blood loss by 129 mL (95% CI, 47 to 211 mL; p = 0.002), the hemoglobin concentration drop by 0.84 g/dL (95% CI, 0.41 to 1.27; p < 0.0001), the length of stay by 1.0 days (95% CI, −0.2 to 2.3 days; p = 0.109), and the cost per episode by £305 (95% CI, £0 to £610; p = 0.05). (In 2010, £1 = 1.5 U.S. dollars.) Oxford Hip Scores and EuroQol scores were similar at three months.
Conclusions: Topically applied tranexamic acid was effective in reducing blood loss and the need for blood transfusion following total hip replacement, avoiding the potential complications of intravenous tranexamic acid administration.
Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | The Journal of Bone and Joint Surgery | ||||
| Publisher: | Journal of Bone and Joint Surgery | ||||
| ISSN: | 0021-9355 | ||||
| Official Date: | 2013 | ||||
| Dates: |
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| Volume: | 95 | ||||
| Number: | 21 | ||||
| Page Range: | pp. 1969-1974 | ||||
| DOI: | 10.2106/JBJS.L.00908 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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