A randomized control trial: effect of tranexamic acid on the need of post-operative blood transfusion following total hip replacement surgery

Deepak Chaudhary, Yasir Ali Khan


Background: Total hip replacement surgery is one of the most advanced and technically demanding surgeries in orthopaedics in which blood loss is inevitable. Most of the patients are elderly with multiple co morbidities and the estimated one-year mortality is about 25%. Objective of the study was to assess the need of post-operative blood transfusion in total hip replacement surgery in patients given tranexamic acid versus control.

Methods: It was a randomized controlled trial. Hundred patients of both sexes undergoing total hip replacement surgery included in study according to inclusion and exclusion criteria after getting written and informed consent. Equal patients 50-50 (50%) divided in two groups tranexamic acid group and control group based on a computer-generated random number table. The tranexamic acid group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and two hours later intravenously. The control group received two doses of 10mg/kg body weight of normal saline at similar intervals. Numbers of blood transfusions required postoperatively were noted based on the postoperative haemoglobin readings.

Results: Mean post-op haemoglobin for the tranexamic acid group was 10.4±2.6 g/dl and for the control group it was 8.6±2.4 g/dl (p=0.007). Eight patients (16%) in intervention group required blood transfusion compared to 22 (44%) in control group (p=0.009). The relative risk (RR) for transfusion was 0.51 when TXA was administered compared to when placebo was administered.

Conclusions: Perioperative tranexamic acid is a safe and useful method of reducing intra op bleeding and need of post-operative blood transfusion postoperatively in THR patients.


Blood transfusion, THR, TXA

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Davidson C, Merrilees MJ, Wilkinson TJ, McKie JS, Gilchrist N. Hip fracture mortality and morbidity - can we do better? N Z Med J. 2001;114:329-32.

Zufferey PJ, Miquet M, Quenet S, Martin P, Adam P, Albaladejo P, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth. 2010;104:23-30.

Marcucci C, Madjdpour C, Spahn DR. Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index. Br Med Bull. 2004;70:15-28.

Vijay BS, Bedi V, Mitra S, Das B. Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries. Saudi J Anaesth. 2013;7:29-32.

Zabeeda D, Medalion B, Sverdlov M, Ezra S, Schachner A, Ezri T, et al. Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization. Ann Thorac Surg. 2002;74:733-8.

Weber BJ, Kjelland CB. The use of tranexamic acid for trauma patients. CJEM. 2012;14:53-6.

Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br. 1996;78:43440.

Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi: 10.1136/bmj.e3054.

Ho K, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care. 2003;31:529-37.