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Tranexamic acid reduces transfusion risk in THA patients

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A single preoperative dose of tranexamic acid was found to significantly lower transfusion rates in patients who underwent total hip arthroplasty but did not impact transfusion rates in patients who underwent hip resurfacing, according to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Gerard March, MD, shared his team’s findings.

“Primary total hip replacement … is increasing in number, and the rate of transfusion reported in the literature has been wide and varied — anywhere from 14% upwards of 40%,” March said. “The purpose of our study was to evaluate the efficacy of a single preoperative bolus … of [tranexamic acid (TXA)] in reducing the allogenic blood transfusion rates both in our experience with total hip replacement and total hip resurfacing.”

March and his team collected retrospective data on an 88-patient cohort that underwent total hip arthroplasty, as well as a 44-patient cohort that underwent hip resurfacing arthroplasty. All patients received a single preoperative bolus of 1 g tranexamic acid (TXA), and the results of their procedures were compared to a control group.

Procedures were all performed at one institution with standardized postoperative care, March reported. Allogenic blood transfusion rate, blood transfusion rate, postoperative day one hemoglobin and overall hemoglobin decrease were all listed as endpoints of the study.

Among the total hip TXA group, March reported a transfusion rate of 5.7%. Among control patients, the transfusion rate was 22.7%. March noted, however, that resurfacing patients actually displayed no statistical difference between the treatment group and matched controls.

Overall hemoglobin decrease in the TXA treatment groups was found to be significantly lower than in the controls. Further, patients who received TXA as well as allogenic blood transfusion were reported by March to display significantly lower preoperative hemoglobin vs. transfusion-negative TXA-treated patients.

“In conclusion, 1 g of tranexamic acid before total hip and resurfacing did have a significant impact upon the mean decrease in hemoglobin, as well as postoperative day one hemoglobin levels,” March said. “It also significantly reduced allogenic blood usage within total hip patients.”


  • March G, Elfatori S, Beaule PE. Single bolus of tranexamic acid (TXA) decreases transfusion risk after primary total hip. Paper #359. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
  • Disclosure: March has no relevant financial disclosures.