Curative Effect Analysis Of The Two Usages Of Tranexamic Acid In First-time Unilateral Total Hip Arthroplasty

Objective: Tranexamic acid(TXA)has been widely used in orthopaedics as an antifibrinolytic agent.It is mainly used in the field of joint surgery to reduce blood loss and transfusion rate during perioperative period.Its curative effect and safety have been studied by a large number of scholars.But so far,no consensus has been reached at home and abroad on its usage,and numerous further studies are needed to find the best usage.This study compared the usage of tranexamic acid in two different applications of first-time unilateral total hip arthroplasty and their effectiveness and safety.Methods: A total of 58 first-time unilateral total hip arthroplasty patients from November 2015 to May 2017 from joint motion department of Nanhua Hospital Affiliated to Nanhua University were retrospectively selected and grouped according to whether tranexamic acid was used and its usages.The 58 cases were divided into A group,B group,C group.In group A(22 cases): Started intravenous injection of tranexamic acid(1.0 g)30 minutes before surgery and finished before cutting skin.In group B(19 cases): Started intravenous injection of tranexamic acid(1.0 g)30 minutes before surgery and finished before cutting skin,before incision closure,1.5 g of tranexamic acid was injected into a partial site of the joint cavity,and the catheter was opened after clamped for 2 hours after it's placed.Group C(17 cases): tranexamic acid was not used.The operative time,average blood transfusion,postoperative drainage,total blood loss,hemoglobin before and after the first day and the third day after surgery,red blood cell volume,coagulation parameters(fibrinogen,prothrombin time,activated partial thromboplastin time)on the first day,the third day,and one week after the operation,postoperative deep vein,thrombosis,pulmonary embolism of each group of patients were collected,statistical analysis was performed on these results,and differences between groups were compared.Results: There was no significant difference in preoperative general conditions(gender,age,height,weight,body mass index)among the three groups(P>0.05).The average postoperative drainage between the three groups was compared: Group B < group A < group C,the difference was statistically significant;the total perioperative blood loss of the three groups of patients was compared: Group C> Group A> Group B,difference between groups was statistically significant(P<0.05).There was no significant difference in the perioperative blood transfusion among the three groups.The hemoglobin(Hb)and hematocrit(HCT)on the first and third day after operation were compared: group B> group A>group C,the difference was statistically significant(P<0.05).There was no significant difference in coagulation parameters between the three groups of patients 1 day after surgery,3 days after operation,and 1 week after operation(P>0.05);The incidence of deep vein thrombosis(DVT)of lower limb and pulmonary embolism(PE)in the three groups of patients after operation was not statistically significant.Conclusions: Transexamic acid(TXA)in first-time unilateral total hip arthroplasty can reduce blood loss,postoperative drainage,and loss of hemoglobin.The effect of intravenous combined topical use is superior to that of intravenous usage alone.There was no significant difference in the occurrence(DVT,PE)and coagulation indexes between the groups.The usage of tranexamic acid did not increase the risk of postoperative deep vein thrombosis of lower limb and pulmonary embolism.