Which route of administration of acid tranexamic, intravenous or intra-articular, is more effective in the control of post-surgical bleeding after a total hip arthroplasty? A prospective, controlled and randomized study

Abstract Introduction One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. Material and method Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15 mg/kg of intravenous TXA were administered in group A and 2 g of intra-articular TXA in group B. The values of haemoglobin and haematocrit were evaluated at 24 h-72 h, blood loss volume, drained blood volume, transfusions and complications. Results 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15 ± 1.64 g/dl in 24 h and 3.75 ± 1.56 g/dl in 72 h, the haematocrit decreased by 10.4 ± 4.17% in 24 h and 11.85 ± 4.15% in 72 h. In the intra-articular group there was a haemoglobin fall of 3.03 ± 1.30 g/dl in 24 h and 3.22 ± 1.2 g/dl in 72 h and the haematocrit fell by 10.66 ± 3.6% and 12.11 ± 3.29% in 24 and 72 h ( p  > .05). The mean drainage in 24 h was 195.80 ml in group A versus 253.93 ml in group B ( p  > .05) and in 48 h it was 225.33 ml in group A and 328.19 ml in group B ( p  = .009). The intravenous group lost an average of 1505 ml of blood compared to the 11,280 ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. Conclusions The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications.