RESUMEN
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA). METHODS: Patients (Nâ=â123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1âg bolus; TXA, topically intra-articularly, 2âg in 50âmL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications. RESULTS: Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA. CONCLUSIONS: The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2âg TXA topically intra-articularly and a repeated bolus of 1âg TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.