Topical Tranexamic Acid and Acute Blood Loss in Total Hip Arthroplasty

Autologous (donor) blood transfusion is an expensive and common occurrence after total hip
replacement. There have been many proposed adjunctive measures to decrease intraoperative
and postoperative blood loss during such surgery. Most of these include thrombin inhibition,
so-called "minimally- invasive" techniques or instrumentation, or other adjunctive drugs.
Hitherto, tranexamic acid, a specific drug that promotes part of the clotting cascade, has
been used extensively in multiple areas of surgery with multiple studies evaluating its
efficacy in cardiac surgery, spinal procedures, and as a dental swishing solution after
tooth extraction. There have been small studies evaluating intravenous tranexamic acid and
its effect on total hip replacements, with some promising results. The topical form of TA
has been evaluated in only one prospective, randomized clinical trial with a significant
decrease in postoperative blood loss and a trend towards decreased autologous blood
transfusion rates. This study proposes to further evaluate tranexamic acid as an inexpensive
and viable option for use in total hip arthroplasty. The topical form of the drug has been
shown to achieve these hemostatic effects without increasing the risk of blood clots after
surgery. A rigorous analysis of the effects of tranexamic acid demand a more standardized
approach. Such a regimen is practiced at Henry Ford Hospital as all patients on the Adult
Reconstruction service are placed on an identical dose of enoxaparin (a subcutaneous blood
thinner) postoperatively for two weeks.

Inclusion Criteria:

- All adult patients over age eighteen

- Primary unilateral total hip arthroplasty at Henry Ford Hospital (Detroit, Michigan,
United States) and Henry Ford West Bloomfield Hospital (West Bloomfield, Michigan,
United States)

Exclusion Criteria:

- patient history of venous thromboembolic disease or coagulopathy

- use of anticoagulant medications within 7 days of surgery

- history of arterial embolic disease

- history of Class III or IV heart failure

- renal failure

- intraoperative cardiovascular, pulmonary, orthopaedic, or anesthetic complication
(MI, intraoperative fracture, vasopressor support, emergent intubation).