Abstract
Background
The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty requires increased utilization of post-operative blood transfusions for acute blood loss anemia compared to elective primary hip replacement. There is limited literature to support the routine use of TEA in revision THA.
Methods
We performed a retrospective review of 161 consecutive patients who underwent revision total hip arthroplasty from 2012–14 at a single institution by two fellowship-trained surgeons. We compared the transfusion requirements and the post-operative hemoglobin drop of the TEA Group (109 patients, 114 hips) versus the No TEA group (52 patients, 56 hips). Our standard protocol for administering TEA is 1000mg IV at incision, and the same dose repeated two hours later. The No TEA group did not receive the medication because of previous hospital contraindication criteria.
Results
The transfusion rate was significantly less for the TEA group (7%) compared to the No TEA group (34%) (p < 0.0001). The mean hemoglobin delta was also significantly less for the TEA group (2.0 ± 1.3 g/dL) compared to the No TEA group (3.5 ± 1.4 g/dL, p < 0.0001). No adverse thromboembolic events occurred in the patients who received TEA.
Conclusion
The routine use of TEA during revision total hip arthroplasty demonstrated a significant reduction in allogenic blood transfusion rates. The post-operative hemoglobin drop was also significantly less with the use of TEA. We recommend the routine use of TEA during revision THA.
