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Acta Ortopédica Mexicana

ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología
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2025, Number 1

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Acta Ortop Mex 2025; 39 (1)

Efficacy of single-dose preoperative tranexamic acid to prevent blood loss in total hip and knee joint replacement

Campos-Flores D, Lameiro-Sánchez F, Galicia-Zamalloa A
Full text How to cite this article 10.35366/118846

DOI

DOI: 10.35366/118846
URL: https://dx.doi.org/10.35366/118846

Language: Spanish
References: 11
Page: 8-12
PDF size: 309.22 Kb.


Key words:

blood transfusion, blood loss, total hip arthroplasty, total knee arthroplasty, tranexamic acid.

ABSTRACT

Introduction: transfusion-related complications are a major concern for surgeons performing total hip and knee arthroplasty (THA and TKA). Several strategies have been implemented to reduce transfusion rates, including the use of tranexamic acid (TXA), whose optimal dosage remains a matter of debate. Objective: to evaluate the efficacy and safety of a single pre-surgical dose of TXA in reducing blood loss in THA and TKA. Material and methods: sixty patients were enrolled. Patients were randomly assigned to either a control group (no TXA) or an experimental group (1 g TXA 30 minutes before surgery). Blood loss, blood transfusion rate and volume, and hemoglobin levels were analyzed. Results: hemoglobin loss in the control group was 3.5 ± 1.4 g/dl compared to 2.5 ± 1.5 g/dl in the experimental group (p = 0.006). Hematocrit loss was 10.6% ± 3.5 in the control group and 8% ± 4.9 in the experimental group (p = 0.02). Blood transfusion was only required in 3 patients (5%): 2 in the control group and 1 in the experimental group (p = 0.4). Conclusions: a single pre-surgical intravenous dose of 1 g TXA reduces hemoglobin loss in patients undergoing THA and TKA.


REFERENCES

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  2. Goldstein M, Feldmann C, Wulf H, Wiesmann T. Tranexamic acid prophylaxis in hip and knee joint replacement. Dtsch Arztebl Int. 2017; 114(48): 824-30. Available in: https://doi.org/10.3238/arztebl.2017.0824

  3. Cho MR, Jun CM, Song SK, Choi WK. Natural course of hemoglobin level after total knee arthroplasty and the benefit of tranexamic acid injection in the joint. Medicine (Baltimore). 2021; 100(35): e27097. Available in: https://doi.org/10.1097/MD.0000000000027097

  4. Sun Q, Yu X, Wu J, Ge W, Cai M, Li S. Efficacy of a single dose and an additional dose of tranexamic acid in reduction of blood loss in total knee arthroplasty. J Arthroplasty. 2017; 32(7): 2108-12. doi: 10.1016/j.arth.2016.10.003.

  5. Xue CX, Yao YF, Lv H, Cheng L, Jing JH. Efficacy and safety of postoperative intravenous tranexamic acid in total knee arthroplasty: a prospective randomized controlled study. Orthop Surg. 2021; 13(8): 2227-35. doi: 10.1111/os.13045.

  6. Poeran J, Chan JJ, Zubizarreta N, Mazumdar M, Galatz LM, Moucha CS. Safety of tranexamic acid in hip and knee arthroplasty in high-risk patients. Anesthesiology. 2021; 135(1): 57-68. doi: 10.1097/ALN.0000000000003772.

  7. Krebs NM, VanWagner MJ, Marchewka T, Faraj U, Vitale CR. Tranexamic acid in the treatment of hip fractures: a clinical review. Spartan Med Res J. 2019; 3(3): 7026. Available in: https://doi.org/10.51894/001c.7026

  8. CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376(9734): 23-32.

  9. Balachandar G, Abuzakuk T. Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose. J Orthop Surg (Hong Kong). 2019; 27(3): 2309499019880915. doi: 10.1177/2309499019880915.

  10. Sanz-Reig J, Parra Ruiz B, Ferrández Martínez J, Martínez López JF. Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla [Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement]. Rev Esp Cir Ortop Traumatol. 2016; 60(2): 106-12. Spanish. Available in: https://doi.org/10.1016/j.recote.2016.01.005

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Acta Ortop Mex. 2025 Ene-Feb;39