Abstract
Tranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response
in total hip arthroplasty. However, studies have not identified an optimal regimen.
The objective of this study was to identify the most effective regimen of multiple-dose
oral TXA in achieving maximum reduction of blood loss and inflammatory response based
on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens
(60 patients each) with control group (group A: matching placebo). The four multiple-dose
regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3
hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours
post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours
post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and
15 hours post-operatively (group E). The primary endpoint was estimated blood loss
on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters,
inflammatory components, function recovery and adverse events. Groups D and E had
significantly less blood loss on POD 3, with no significant difference between the
two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic
parameters remained within normal ranges. Group E had the lowest levels of inflammatory
cytokines and the greatest range of motion. No thromboembolic complications were observed.
The post-operative four-dose regimen brings about maximum efficacy in reducing blood
loss, alleviating inflammatory response and improving analgaesia and immediate recovery.
Keywords blood loss - inflammation - oral tranexamic acid - total hip arthroplasty - thrombosis
