Effect of Routes of Administration of Tranexamic Acid in Peri-Operative Blood Loss in Total Hip Arthroplasty: A Prospective Comparative Study

Introduction: Perioperative blood loss is a significant challenge in total hip arthroplasty (THA), and it often necessitates blood transfusion. Tranexamic acid (TXA), an antifibrinolytic agent, is widely used to reduce surgical blood loss, but to date; there is no clear consensus on the optimal and most efficacious route of administration of TXA. Therefore, this study was planned to evaluate and compare the efficacy of different routes of administration of TXA in reducing perioperative blood loss through a prospective comparative study. Materials and Methods: A total of 102 patients undergoing elective unilateral THA were enrolled and randomized into three cases and their three control groups of 17 patients each. The patients in group A (intravenous [IV]-TXA group) received IV-TXA while its control Group D received an equivalent amount of IV normal saline (NS). Group B (Topical-TXA group), received topical TXA, while its control Group E received an equivalent amount of NS at similar stages in a similar fashion. Group C (combined-TXA group) received IV as well as topical TXA, while its control Group F received an equivalent amount of NS at similar stages. Perioperative blood loss was measured from suction cylinders, mop weight and drain output. Statistical analysis included analysis of variance, post hoc Tukey tests, and independent t-tests. Results: All TXA groups showed reduced blood loss as compared to their controls. Among these, the combined-TXA group demonstrated the lowest total mean blood loss (629.29 ± 26.33 mL), followed by the IV-TXA and topical-TXA group. These differences were statistically significant (P < 0.05). No adverse events were reported in the case or control groups. Conclusion: The route of TXA administration plays a significant role in its efficacy in reducing perioperative blood loss. The combined (IV+ Topical) route is more effective in reducing intraoperative and post-operative blood loss as compared to IV or topical routes. Keywords: Tranexamic acid, total hip arthroplasty, perioperative blood loss.