Combined administration of tranexamic acid and vitamin K proved perioperative blood loss reduction with cementless total hip replacement: a prospective randomized controlled study

Introduction Blood loss during total joint replacement has serious implications on patients affecting their ability to immediately start the postoperative enhanced recovery program. Tranexamic acid (TA) is well known for its ability to reduce blood loss during arthroplasty. Vitamin K has an important physiological role in the clotting cascade, but its action is delayed and dose sensitive. Study settings and design A prospective comparative study conducted in Benha University Hospital. Patients and methods In all, 150 patients were randomly divided into three groups, each included 50 patients. Group A received both TA and vitamin K1, group B received only vitamin K1, and group C received only TA. Perioperative blood parameters tested included hemoglobin level, hematocrit percentage, platelet count, prothrombin time, partial thromboplastin time, and fibrinogen level. Intraoperative and postoperative blood losses and the amount of blood transfusion were reported. A surgeon satisfaction score was created to assess the degree of intraoperative bleeding. Results The mean perioperative differences in blood parameters and amount of blood loss were evaluated with the post-hoc test. Group A showed a statistically significant less changes in blood parameters and less blood loss than the other groups, and group B showed less postoperative blood losses. Conclusion Combined administration of TA and vitamin K with cementless total hip replacement proved efficient in reducing intraoperative and postoperative blood losses and the need for blood transfusion. This was reflected on the patient’s ability to start the enhanced recovery program immediately, reduced the duration of postoperative hospital stay, and the overall cost of operation.