• Ze-Yu Luo, Duan Wang, Wei-Kun Meng, Hao-Yang Wang, Hui Pan, Fu-Xing Pei, and Zong-Ke Zhou.
• Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, 610041, PR China.
• Thromb. Res. 2018 Jul 1; 167: 1-5.

PurposeTo compare the efficacy of multiple doses of oral tranexamic acid (TXA) with topical TXA administration in reducing blood loss following total hip arthroplasty (THA).Patients And MethodsIn this double-blinded trial, 117 patients undergoing primary THA were randomized to receive 2 g TXA orally 2 h preoperatively, and two doses of 1 g TXA postoperatively (oral group) or 3 g of TXA topical administration in the operating room (topical group). The primary outcome was a reduction in hemoglobin concentration. Other outcomes-such as blood loss, TXA-related cost (¥), length of hospital stay (days), complications such as pulmonary thromboembolism (PE), deep vein thrombosis (DVT), and infection, blood coagulation and fibrinolysis, and hip function-were recorded.ResultsThe mean reduction in hemoglobin level was similar between the oral and topical groups (3.07 g/dL compared with 3.12 g/dL; p = 0.85). Similarly, there was no significant difference in the mean total blood loss between oral and topical administration (863 mL compared with 902 mL; p = 0.62). Three patients received an allogeneic blood transfusion, including one patient in the oral group and two patients in the topical group (p = 0.55). The oral group had a significantly lower TXA-related cost than the topical group: ¥944 and ¥4359, respectively (p = 0.01). No PE, DVT, cardiac infarction or renal failure occurred during the 90-day follow-up. The coagulation and fibrinolysis parameters were similar between the two groups.ConclusionOral TXA is equivalent to topical TXA administration in the reduction of blood loss in the setting of primary THA without drainage.Copyright © 2018. Published by Elsevier Ltd.

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