Analysis of hemostatic effect and safety of tranexamic acid in primary simultaneous bilateral total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DENG Zengfa , SHENG Puyi , XU Dongliang , FU Ming , HE Aishan , LIAO Weiming ,  KANG Yan

Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China;

Corresponding author：

KANG Yan, Email: neokang@163.com

Keywords：

Tranexamic acid; total hip arthroplasty; bilateral arthroplasty; blood loss; safety

DOI：

10.7507/1002-1892.201911083

Video：

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Objective To explore the effect of tranexamic acid (TXA) on the transfusion rate, dominant blood loss, and postoperative complications in simultaneous bilateral total hip arthroplasty (SBTHA).Methods A clinical data of 72 patients who underwent the primary SBTHA between January 2010 and December 2018 was retrospectively analyzed. A single dose of 15 mg/kg TXA was administered intravenously before 5-10 minutes of operation in 48 patients of trial group and 24 patients were not treated with TXA in the control group. There was no significant difference between the two groups (P>0.05) in the gender, age, body mass index, the type of disease, American Society of Anesthesiologists (ASA) grading, comorbidity, and preoperative hospital stay, hemoglobin, hematocrit, platelet count, coagulation function tests. The operation time, intraoperative blood loss, and postoperative transfusion rate, dominant blood loss, complication, and hospital stay were recorded and compared between the two groups.Results The median operation time of the trial group was 208.0 minutes, and that of the control group was 202.5 minutes, with no significant difference (Z=−1.046, P=0.295). Postoperative transfusion was performed in 26 patients (54.2%) in the trial group and 21 patients (87.5%) in the control group, and the difference of transfusion rate between the two groups was significant (χ²=7.843, P=0.005). However, there was no significant difference in the amount of transfused suspended red blood cells and plasma between the two groups (P>0.05). The median intraoperative blood loss was 550 mL in the trial group and 600 mL in the control group, with no significant difference (Z=−1.378, P=0.168). The postoperative drainage volume and median dominant blood loss in the trial group were (542±269) and 1 050 mL, respectively, which were significantly lower than those in the control group [(710±316) and 1 270 mL] (P<0.05). There was 1 case of skin tension blisters around the incision, 1 case of lower limb numbness and muscle strength loss, and 1 case of lacunar cerebral infarction in the trial group, while in the control group, there was 1 case of skin ecchymosis around the incision and 1 case of bilateral lower limb numbness and muscle strength loss, which showed no significant difference in the incidences of complications (P>0.05). No pulmonary embolism or deep venous thrombosis was found in the two groups. The median postoperative hospital stay and median total hospital stay were 9.0 and 13.0 days in the trial group, while 9.0 and 13.0 days in the control group, respectively, with no significant difference (P>0.05).Conclusion For patients who are treated with the primary SBTHA, TXA can reduce transfusion rate and perioperative dominant blood loss, and has a good hemostatic effect without increasing complications of incision, pulmonary embolism, deep venous thrombosis, and hospital stay. Therefore, TXA is relative safe.

Citation： DENG Zengfa, SHENG Puyi, XU Dongliang, FU Ming, HE Aishan, LIAO Weiming, KANG Yan. Analysis of hemostatic effect and safety of tranexamic acid in primary simultaneous bilateral total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 889-894. doi: 10.7507/1002-1892.201911083 Copy

1.	Branson JJ, Goldstein WM. Primary total hip arthroplasty. AORN J, 2003, 78(6): 947-953.
2.	Talia AJ, Coetzee C, Tirosh O, et al. Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial. Trials, 2018, 19(1): 13.
3.	Shao H, Chen CL, Maltenfort MG, et al. Bilateral total hip arthroplasty: 1-stage or 2-stage? A meta-analysis. J Arthroplasty, 2017, 32(2): 689-695.
4.	Morcos MW, Hart A, Antoniou J, et al. No difference in major complication and readmission rates following simultaneous bilateral vs unilateral total hip arthroplasty. J Arthroplasty, 2018, 33(8): 2541-2545.
5.	Edwards D, Anderson A, Pleus MR, et al. Factors affecting discharge disposition after primary simultaneous bilateral joint arthroplasty. HSS J, 2019, 15(3): 254-260.
6.	Tan Z, Cao G, Wang G, et al. Total hospital cost, length of stay, and complications between simultaneous and staged bilateral total hip arthroplasty: A nationwide retrospective cohort study in China. Medicine (Baltimore), 2019, 98(11): e14687.
7.	吴俊, 李广翼, 陈云苏, 等. 三种氨甲环酸联合用药方案在初次人工全膝关节置换术中的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1397-1401.
8.	张少云, 肖聪, 裴福兴. 氨甲环酸在创伤骨科手术中应用的研究进展. 中国修复重建外科杂志, 2019, 33(11): 1457-1461.
9.	Tengborn L, Blombäck M, Berntorp E. Tranexamic acid—an old drug still going strong and making a revival. Thromb Res, 2015, 135(2): 231-242.
10.	Cao G, Huang Z, Huang Q, et al. Incidence and risk factors for blood transfusion in simultaneous bilateral total joint arthroplasty: A multicenter retrospective study. J Arthroplasty, 2018, 33(7): 2087-2091.
11.	岳辰, 马俊, 杨沛青, 等. 氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究. 中国矫形外科杂志, 2014, 22(10): 865-869.
12.	Partridge TCJ, Charity JAF, Sandiford NA, et al. Simultaneous or staged bilateral total hip arthroplasty? An analysis of complications in 14, 460 patients using national data. J Arthroplasty, 2020, 35(1): 166-171.
13.	Huang L, Xu T, Li P, et al. Comparison of mortality and complications between bilateral simultaneous and staged total hip arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(39): e16774.
14.	Kim JL, Park JH, Han SB, et al. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: A meta-analysis. J Arthroplasty, 2017, 32(1): 320-325.
15.	Sassoon A, Nam D, Jackups R, et al. Tranexamic acid: optimal blood loss management in surface replacement arthroplasty. Bone Joint J, 2016, 98-B(2): 173-178.
16.	Evangelista PJ, Aversano MW, Koli E, et al. Effect of tranexamic acid on transfusion rates following total joint arthroplasty: A cost and comparative effectiveness analysis. Orthop Clin North Am, 2017, 48(2): 109-115.
17.	Chang CH, Chang Y, Chen DW, et al. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res, 2014, 472(5): 1552-1557.
18.	崔丹荔, 雷一霆, 许宏, 等. 人工全髋关节置换术中首次大剂量联合术后五次静脉应用氨甲环酸的前瞻性临床研究. 中国修复重建外科杂志, 2019, 33(8): 935-939.
19.	Nakura N, Hirakawa K, Takayanagi S, et al. Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study. Transfusion, 2017, 57(4): 977-984.
20.	Wu YG, Zeng Y, Shen B, et al. Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial. Hip Int, 2016, 26(4): 331-337.
21.	郭家庆, 孙永红. 氨甲环酸对减少同期双侧全髋关节置换术围术期出血的疗效观察. 中国医院用药评价与分析, 2018, 18(8): 1066-1067, 1069.
22.	顾建明, 李为, 杜辉, 等. 氨甲环酸对减少同期双侧全髋关节置换术围术期出血的疗效. 武警医学, 2016, 27(2): 119-122.
23.	Boyle JA, Soric MM. Impact of tranexamic acid in total knee and total hip replacement. J Pharm Pract, 2017, 30(1): 89-93.
24.	张权, 孙立, 胡如印, 等. 关节腔内使用氨甲环酸对同期双侧人工全髋关节置换术后失血量的影响. 贵阳医学院学报, 2015, 40(5): 500-503.
25.	Benoni G, Fredin H, Knebel R, et al. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand, 2001, 72(5): 442-448.
26.	Sukeik M, Alshryda S, Powell J, et al. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon, 2020, 18(1): 53-61.
27.	Mufarrih SH, Malik AT, Qureshi NQ, et al. The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study. Int J Surg, 2018, 52: 25-29.
28.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华关节外科杂志 (电子版), 2009, 3(3): 380-383.

1. Branson JJ, Goldstein WM. Primary total hip arthroplasty. AORN J, 2003, 78(6): 947-953.
2. Talia AJ, Coetzee C, Tirosh O, et al. Comparison of outcome measures and complication rates following three different approaches for primary total hip arthroplasty: a pragmatic randomised controlled trial. Trials, 2018, 19(1): 13.
3. Shao H, Chen CL, Maltenfort MG, et al. Bilateral total hip arthroplasty: 1-stage or 2-stage? A meta-analysis. J Arthroplasty, 2017, 32(2): 689-695.
4. Morcos MW, Hart A, Antoniou J, et al. No difference in major complication and readmission rates following simultaneous bilateral vs unilateral total hip arthroplasty. J Arthroplasty, 2018, 33(8): 2541-2545.
5. Edwards D, Anderson A, Pleus MR, et al. Factors affecting discharge disposition after primary simultaneous bilateral joint arthroplasty. HSS J, 2019, 15(3): 254-260.
6. Tan Z, Cao G, Wang G, et al. Total hospital cost, length of stay, and complications between simultaneous and staged bilateral total hip arthroplasty: A nationwide retrospective cohort study in China. Medicine (Baltimore), 2019, 98(11): e14687.
7. 吴俊, 李广翼, 陈云苏, 等. 三种氨甲环酸联合用药方案在初次人工全膝关节置换术中的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1397-1401.
8. 张少云, 肖聪, 裴福兴. 氨甲环酸在创伤骨科手术中应用的研究进展. 中国修复重建外科杂志, 2019, 33(11): 1457-1461.
9. Tengborn L, Blombäck M, Berntorp E. Tranexamic acid—an old drug still going strong and making a revival. Thromb Res, 2015, 135(2): 231-242.
10. Cao G, Huang Z, Huang Q, et al. Incidence and risk factors for blood transfusion in simultaneous bilateral total joint arthroplasty: A multicenter retrospective study. J Arthroplasty, 2018, 33(7): 2087-2091.
11. 岳辰, 马俊, 杨沛青, 等. 氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究. 中国矫形外科杂志, 2014, 22(10): 865-869.
12. Partridge TCJ, Charity JAF, Sandiford NA, et al. Simultaneous or staged bilateral total hip arthroplasty? An analysis of complications in 14, 460 patients using national data. J Arthroplasty, 2020, 35(1): 166-171.
13. Huang L, Xu T, Li P, et al. Comparison of mortality and complications between bilateral simultaneous and staged total hip arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(39): e16774.
14. Kim JL, Park JH, Han SB, et al. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: A meta-analysis. J Arthroplasty, 2017, 32(1): 320-325.
15. Sassoon A, Nam D, Jackups R, et al. Tranexamic acid: optimal blood loss management in surface replacement arthroplasty. Bone Joint J, 2016, 98-B(2): 173-178.
16. Evangelista PJ, Aversano MW, Koli E, et al. Effect of tranexamic acid on transfusion rates following total joint arthroplasty: A cost and comparative effectiveness analysis. Orthop Clin North Am, 2017, 48(2): 109-115.
17. Chang CH, Chang Y, Chen DW, et al. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res, 2014, 472(5): 1552-1557.
18. 崔丹荔, 雷一霆, 许宏, 等. 人工全髋关节置换术中首次大剂量联合术后五次静脉应用氨甲环酸的前瞻性临床研究. 中国修复重建外科杂志, 2019, 33(8): 935-939.
19. Nakura N, Hirakawa K, Takayanagi S, et al. Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study. Transfusion, 2017, 57(4): 977-984.
20. Wu YG, Zeng Y, Shen B, et al. Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial. Hip Int, 2016, 26(4): 331-337.
21. 郭家庆, 孙永红. 氨甲环酸对减少同期双侧全髋关节置换术围术期出血的疗效观察. 中国医院用药评价与分析, 2018, 18(8): 1066-1067, 1069.
22. 顾建明, 李为, 杜辉, 等. 氨甲环酸对减少同期双侧全髋关节置换术围术期出血的疗效. 武警医学, 2016, 27(2): 119-122.
23. Boyle JA, Soric MM. Impact of tranexamic acid in total knee and total hip replacement. J Pharm Pract, 2017, 30(1): 89-93.
24. 张权, 孙立, 胡如印, 等. 关节腔内使用氨甲环酸对同期双侧人工全髋关节置换术后失血量的影响. 贵阳医学院学报, 2015, 40(5): 500-503.
25. Benoni G, Fredin H, Knebel R, et al. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand, 2001, 72(5): 442-448.
26. Sukeik M, Alshryda S, Powell J, et al. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon, 2020, 18(1): 53-61.
27. Mufarrih SH, Malik AT, Qureshi NQ, et al. The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study. Int J Surg, 2018, 52: 25-29.
28. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华关节外科杂志 (电子版), 2009, 3(3): 380-383.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of hemostatic effect and safety of tranexamic acid in primary simultaneous bilateral total hip arthroplasty

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