Xie J, et al. - Efficacy and safety of multiple boluses of intravenous (IV) tranexamic acid (TXA) on the hidden blood loss (HBL) and inflammatory response following primary total hip arthroplasty (THA) was investigated in this study. Findings demonstrated that an effective attenuation of postoperative HBL could be achieved with the use of multiple boluses of IV-TXA. Furthermore, a smaller decrease in the level of haemoglobin (Hb), less post-operative inflammation and a shorter length of stay in hospital were achieved with a regimen comprising three boluses vs a single bolus.

Methods

• In this study, researchers randomly assigned a total of 150 patients to receive a single bolus of 20 mg/kg IV TXA before the incision (group A), a single bolus followed by a second bolus of 1 g IV-TXA three hours later (group B) or a single bolus followed by two boluses of 1 g IV-TXA three and six hours later (group C).
• A standard peri-operative enhanced recovery protocol was used to treat all patients.
• Primary outcomes were HBL and the level of haemoglobin (Hb) as well as the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers of inflammation.
• The length of stay in hospital and the incidence of venous thromboembolism (VTE) were the secondary outcomes.

Results

• Findings demonstrated that the mean HBL was significantly lower in group C (402.13 ml standard deviation (sd) 225.97) than group A (679.28 ml sd 277.16, p < 0.001) or B (560.62 mlsd 295.22, p=0.010).
• Researchers also observed that the decrease in the level of Hb between the pre-operative baseline and the level on the third post-operative day was 30.82 g/L (sd 6.31 g/L) in group A, 27.16 g/L (sd 6.83) in group B and 21.98 g/L (sd 3.72) in group C.
• Among the three groups, this decrease significantly differed (p < 0.01).
• In group C, compared with the other two groups, the mean level of CRP was significantly lower on the second (p ≤ 0.034) and third post-operative days (p ≤ 0.014).
• In addition, group C demonstrated significantly lower levels of IL-6 than group A on the first three post-operative days (p=0.023).
• In group C vs group A, the mean length of stay was significantly lower (p=0.023).
• Data did not report the occurrence of VTE or other adverse events.