Analysis Of The Efficacy Of A Single Preoperative Intravenous Dose Of Tranexamic Acid At Different Doses In Primary Total Hip Replacement

Background:As one of the orthopaedic surgeries of the century,Total hip arthroplasty(THA)is the most effective treatment for various end-stage hip diseases,to rebuild the joint function of patients and improve the quality of life.With the aging of the population and the coverage of the medical security system,the demand for total hip replacement is increasing year by year.However,clinicians are troubled by perioperative blood loss due to surgical trauma and the associated risk of complications associated with higher transfusion rates affecting patient outcomes.With the improvement of clinical blood management measures,studies have found that Tranexamic acid(TXA)is significantly effective in reducing perioperative blood loss during total hip replacement,but there is no uniform standard on the optimal dose and safety of intravenous administration.Objective:1.To compare the hemostatic effect and complications among patients with different intravenous dosages,so as to provide data support for exploring the optimal single intravenous dosages before primary total hip replacement;2.In order to further explore the hemostatic effect and safety of single intravenous administration of large dose before surgery in primary total hip replacement,data were accumulated.Methods:A total of 90 patients(45 males and 45 females)who underwent primary total hip arthroplasty for osteoarthritis,avonecrosis of the femoral head,developmental dysplasia of the hip(CroweⅠ,Ⅱ),femoral neck fracture,and rheumatoid arthritis from January 2019 to September 2021 in Department of Joint Surgery,the First Affiliated Hospital of Dali University were retrospectively analyzed.The age ranged from 44 to80 years,with an average age of 59.9±7.8 years.Group A: 10mg/Kg<TXA ≦ 20mg/Kg:there were 30 cases in this group,including 16 females and 14 males,aged from 44 to75 years,with an average age of 59.3±7.9 years.Group B: 20mg/Kg<TXA ≦ 30mg/Kg group: there were 30 cases in this group,including 13 females and 17 males,aged between 48 and 74 years,with an average age of 57.7±6.6 years.Group C:30mg/Kg<TXA ≦40mg/Kg group: there were 30 cases in this group,including 16 females and 14 males,aged from 50 to 80 years,with an average age of 63.0±7.8 years.For the three groups of patients,the time of administration was 15 minutes before skin incision and the mode of administration was intravenous drip.Results : Comparison of postoperative drainage in the three groups: group A(121.00±53.68)ml,group B(122.93±84.17)ml and group C(112.59±61.91)ml showed no statistically significant difference between the groups(P>0.05).Total perioperative blood loss: group C(570.06±193.42)ml was significantly lower than group B(787.83±308.52)ml and group A(978.58±498.05)ml,and the difference was statistically significant(P<0.05);group B(787.83±308.52)ml was significantly lower than group A(978.58±498.05)ml,and the difference was statistically significant(P <0.05).Occult blood loss: B(481.23±254.92)ml and group C(310.22±198.65)ml were significantly lower than group A(699.24±503.38)ml,and the difference was statistically significant(P<0.05);C(310.22±198.65)ml was significantly lower than group B(481.23±254.92)ml,and the difference was statistically significant(P < 0.05).Significant blood loss: group A(289.33±66.41)ml,group B(301.00±135.73)ml and group C(259.83±95.83)ml showed no statistically significant difference between groups(P>0.05).Transfusion rate: 8 patients in group A had blood transfusion,the transfusion rate was 26.7%,3 patients in group B had blood transfusion,the transfusion rate was 10%,and 1 patient in group C had blood transfusion,the transfusion rate was3.3.%.the transfusion rate in group A was significantly higher than that in group C,the difference between groups was statistically significant(P < 0.05),the difference between groups A and B,group B and group C in terms of transfusion rate was not statistically significant(P > 0.05).Postoperative complications: all patients in the three groups had lower limb deep vein thrombosis and pulmonary embolism after surgery,and no infection occurred at the surgical port.Conclusion : In the dose range of 10mg/Kg-40mg/Kg,a single intravenous dose of tranexamic acid 30mg/Kg-40mg/Kg 15 minutes before skin incision can significantly reduce the total perioperative blood loss,occult blood loss and transfusion rate in patients undergoing primary total hip replacement,and does not increase the risk of venous thromboembolism in patients.