Controlled clinical trial using tranexamic acid in primary non-cemented total hip replacement

Total hip replacement (THR) is one of the surgical procedures that has the highest success rate in functional improvement and patient satisfaction. The procedure is associated with significant blood loss leading to acute anemia and transfusion requirements in 29.8% of cases. Blood transfusion is not a free complications procedure. Transmitted diseases, anaphylaxis, haemolytic reactions, low availability and financial charges are limiting factors. Antifibrinolytic agents, such as aprotinin and tranexamic acid, have proven to be effective in reducing blood loss, especially in cardiac surgery. Tranexamic acid is a synthetic amino acid derivative of lysine. It inhibits fibrinolysis by reversible blockade of lysine coupling the plasminogen molecule, preventing its activation to plasmin. Its action, therefore, it is in the later stage of clot formation or, more precisely, extending the time of dissolution of the fibrin network. Considering the role of the National Institute of Traumatology and Orthopedics Jamil Haddad (INTO) in the formulation of the national health policy guidelines, the effects of intravenous single dose of tranexamic acid in bleeding and blood transfusion in cementless primary total hip arthroplasty. This is a prospective, randomized study conducted with 256 patients between December 2013 and March 2014. The sample was divided into two groups: patients who received tranexamic acid (ATX group, n =128) and patients who did not (Control group, n=128). The drug administration was carried out by intravenous infusion bolus at a dose of 15 mg/kg. The ATX group showed less decline in Hb and Ht postoperative (p<0.0001), as well as the blood loss volume during surgery, 652.9 mL in the ATX group and 1163.0 mL in the control group (p<0.0001). The need for blood transfusion was reduced from 32% in the control group to 14.1% in the ATX group (p=0.001). Among the patients who underwent blood transfusion, the use of tranexamic acid resulted in a significant decrease in the infused blood volume (p <0.0001). There was a significant reduction in rates of blood transfusion and blood volume transfused in the group with risk factor for blood transfusion (preoperative Hb less than 13 g/dL). The hospital length stay was lower in the group using the ATX, including the group with risk for blood transfusion. In neither group was observed adverse events such as thromboembolic events. The use of tranexamic acid intravenously in a single dose before surgery is safe, reduces the operative blood loss and the need for transfusion in patients undergoing THR.