Weight-Based Tranexamic Acid is More Effective in Reducing Postoperative Blood Loss Compared to a Fixed-Dose Regimen in Revision Hip Arthroplasty: A Comparative Study.

Abstract

Background: The optimal dose of intravenous tranexamic acid (TXA) for surgical use remains uncertain. This study aimed to compare the postoperative blood loss, perioperative transfusion rate, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total hip arthroplasty (rTHA).

Methods: We conducted a retrospective comparative analysis of 377 patients who underwent rTHA between March 2004 and March 2024, categorizing them into three groups based on the TXA regimen: (1) the no-TXA group; (2) the fixed-dose TXA group, who received one gram of intravenous TXA before skin incision, with an additional one gram of topical TXA; and (3) the weight-based TXA group, who received a weight-adjusted dose of 20 mg/kg/hour of intravenous TXA before skin incision, with an additional one gram of topical TXA. The maximal decrease in hemoglobin (Hb), perioperative transfusion rate, and incidence of in-hospital mortality and complications were recorded.

Results: The maximal decrease in Hb levels was lower in the weight-based TXA group than in both the no TXA and fixed-dose TXA groups (27.8 versus 41.9 g/L, P < 0.001, and 27.8 versus 39.0 g/L, P < 0.001, respectively). However, it did not differ between the no-TXA and fixed-dose TXA groups. Both the fixed-dose and weight-based TXA groups had lower perioperative transfusion rates than the no-TXA group (P < 0.001). Additionally, the perioperative transfusion rate was lower in the fixed-dose TXA group than in the weight-based TXA group (P < 0.001). Changes in the dose of intravenous TXA did not significantly impact mortality or major complications in the three groups.

Conclusion: Compared with fixed-dose TXA, a weight-based TXA dose was associated with less postoperative blood loss in rTHA without increasing the incidence of in-hospital mortality or major complications. Surgeons should consider implementing the weight-based TXA regimen in rTHA to effectively mitigate postoperative blood loss.