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Thromb Haemost 2019; 119(01): 092-103
DOI: 10.1055/s-0038-1676625
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

Duan Wang   *
1   Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
,
Yang Yang   *
2   State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
,
Chuan He   *
3   Department of Hematology, Hematology Research Laboratory, West China Hospital, Sichuan University, Chengdu, China
,
Ze-Yu Luo
1   Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
,
Fu-Xing Pei
1   Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
,
Qi Li
1   Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
,
Zong-Ke Zhou
1   Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
,
Wei-Nan Zeng
4   Center for Joint Surgery, Third Military Medical University, Southwest Hospital, Chongqing, China
› Author Affiliations
Further Information

Publication History

20 July 2018

01 November 2018

Publication Date:
31 December 2018 (online)

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Abstract

Tranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

Keywords

blood loss - inflammation - oral tranexamic acid - total hip arthroplasty - thrombosis

Supplementary Material

 

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