The Effect of Preoperative Administration of Intravenous Tranexamic Acid During Revision Hip Arthroplasty: A Retrospective Study

• Published in: Journal of bone and joint surgery. American volume 2018-09, Vol.100 (17), p.1509-1516
• Main Authors: Peck, Jonathan, Kepecs, David M, Mei, Bill, Safir, Oleg A, Backstein, David, Gross, Allan E, Kuzyk, Paul R
• Format: Article
• Language: English
• Subjects: Acetabulum - injuries; Acetabulum - surgery; Aged; Aged, 80 and over; Antifibrinolytic Agents - administration & dosage; Arthroplasty, Replacement, Hip - methods; Blood Loss, Surgical - prevention & control; Blood Transfusion - statistics & numerical data; Fractures, Bone - surgery; Hip Fractures - surgery; Humans; Infusions, Intravenous; Intraoperative Care - methods; Intraoperative Care - statistics & numerical data; Middle Aged; Periprosthetic Fractures - surgery; Postoperative Complications - surgery; Preoperative Care - methods; Reoperation; Retrospective Studies; Surgical Wound Infection - surgery; Tranexamic Acid - administration & dosage; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.17.01212

BACKGROUND:Revision hip arthroplasty poses several challenges, including the management of perioperative blood loss. Recent studies have validated the use of tranexamic acid in primary total hip arthroplasty, showing reduced blood loss and decreased number of allogenic blood transfusions. The effectiveness of tranexamic acid has not been well studied in the revision hip arthroplasty setting. METHODS:We performed a retrospective review of 1,072 patients who underwent revision hip arthroplasty at our institution from 2008 to 2016. A total of 634 patients met the inclusion criteria, and comparisons were made between 232 consecutive patients without the use of tranexamic acid and 402 consecutive patients with the use of tranexamic acid. Patients were subdivided into 4 groups based on the complexity of revision surgical procedures(1) major revision, (2) isolated femoral component revision, (3) isolated acetabular component revision, and (4) isolated femoral head and acetabular liner exchange. Within these groups, we compared the demographic data, estimated intraoperative blood loss, perioperative blood units transfused, postoperative hemoglobin drop, and thromboembolic complications between patients receiving either tranexamic acid or no antifibrinolytic therapy. RESULTS:The primary outcomes of our study (estimated intraoperative blood loss, postoperative hemoglobin drop, and perioperative blood transfusion) were all reduced in patients who received tranexamic acid compared with patients who received no antifibrinolytic therapy. When analyzed on the basis of the complexity of surgical revision, there was a decrease in estimated intraoperative blood loss following tranexamic acid administration in the major revision group (845 compared with 1,095 mL; p < 0.001). The postoperative drop in hemoglobin was lower in the major revision group with tranexamic acid administration (by 8.9 g/L; p < 0.01) and the isolated acetabular component revision group with tranexamic acid administration (by 11.9 g/L; p < 0.001). The need for perioperative blood transfusion was reduced across all revisions treated with tranexamic acid (major revision group, 1.79 compared with 3.33 units, p < 0.001; femoral revision only, 0.97 compared with 2.25 units, p < 0.01; acetabular revision only, 0.73 compared with 1.72 units, p < 0.001; and head and liner exchange, 0.15 compared with 0.89 unit, p < 0.05). CONCLUSIONS:Based on this study, preoperative administration of intravenous tranexamic aci