Transfusion rates with intravenous tranexamic acid in total hip arthroplasty performed using the direct anterior approach

Reducing transfusion in hip arthroplasty: tranexemic acid diminishes influence of anesthesia administered

BACKGROUND

The risk of transfusion following total hip arthroplasty (THA) continues to be problematic. The best choice of anesthesia (spinal vs general) and impact of tranexamic acid (TXA) use in reducing transfusions following surgery remain unclear. Therefore, the purpose of this study was to compare rates of blood transfusion following THA via the anterior approach using three different anesthesia protocols with and without TXA.

MATERIALS AND METHODS

This retrospective review included 1399 patients (1659 hips), receiving spinal anesthesia (SA) without (248 patients) and with TXA (77 patients), general anesthesia (GA) without (151 patients) and with TXA (171) and general anesthesia with paravertebral block (GA-PVB) and TXA (748 patients). All procedures were performed by a single surgeon. Chi-Squared tests and logistic regression were performed to evaluate the rate and risks of transfusion between groups.

RESULTS

Without TXA, transfusion rate with GA (24.5%) was higher than SA (13.4%) (p = 0.004). With TXA, there was no difference in transfusion rates between GA (4.6%), SA (3.9%) or GA-PVB (4.0%). The multivariable regression revealed bilateral (Odds Ratio (OR): 6.473; p < 0.001), female (OR: 2.046; p = 0.004), age (OR: 1.028; p = 0.012) and pre-operative anemia (OR: 2.604; p < 0.001) as increasing the risk of transfusion while use of TXA (OR: 0.168; p < 0.001) significantly reduced transfusion risk.

CONCLUSION

The use of TXA during THA via the anterior approach removed the influence of anesthesia type regarding risk of transfusion. The use of TXA may reverse presumed disadvantages of GA alone, potentially facilitating rapid discharge following surgery.

Tranexamic acid reduces blood loss in primary total hip arthroplasty performed using the direct anterior approach: a one-center retrospective observational study

BACKGROUND

It is still unknown whether tranexamic acid (TXA) is beneficial for the minimally invasive surgical approach to total hip arthroplasty (THA). The aim of this study is to investigate the efficacy and safety of intravenous TXA in primary THA via the direct anterior approach (DAA).

MATERIALS AND METHODS

We performed a retrospective analysis of prospectively collected data on 70 patients with nontraumatic avascular necrosis of the femoral head who underwent THA via the DAA between October 2017 and October 2018. Patients were divided into two groups: TXA group (39 patients received 1.5 g TXA intravenously) and control group (31 patients did not receive TXA). Patients were assessed by operative time, postoperative hemoglobin (HB) drop, transfusion rate, postoperative length of hospital stays (LHS), deep vein thrombosis (DVT), and Harris hip score (HHS).

RESULTS

Total blood loss, hidden blood loss, and postoperative HB drop in the TXA group were significantly lower than in the control group (p < 0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, operative time, transfusion rate, postoperative LHS, HHS, or incidence of DVT (p > 0.05).

CONCLUSIONS

TXA may reduce perioperative blood loss without increasing complications in THA via the DAA.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Perioperative strategies to reduce transfusion rates in one-stage bilateral total hip arthroplasty via direct anterior approach

Despite several blood management strategies available, blood transfusion rates following total hip arthroplasty remain high. Therefore, this study evaluated transfusion rates following bilateral hip arthroplasty via direct anterior approach using a multimodal blood loss management approach for 213 consecutive patients. All patients received standard surgical and post-operative procedures, with allogenic transfusion performed if hemoglobin was less than 8.0 g/dL with persistent clinical symptoms. Thirty-two patients (15%) required transfusion, with those patients significantly older and had lower pre-operative hemoglobin compared to non-transfusion patients. This transfusion rate was much lower than previous literature and could be an appropriate, multimodal blood loss management strategy.