Moderate strength evidence supports that the practitioner could use intravenous or topical tranexamic acid for patients with symptomatic osteoarthritis of the hip who are undergoing total hip arthroplasty (THA) as a part of the effort to reduce blood loss.

Rationale
Two high quality (Martin et al, Niskanen et al) and two moderate strength (Imai et al, Benoni et al) studies evaluated the perioperative use of tranexamic acid (TXA) for total hip arthroplasty (THA). Martin, et al conducted a prospective, stratified, randomized, double-blind, placebo-controlled trial that demonstrated that the use of topical TXA in THA resulted in a smaller reduction in postoperative hemoglobin. There was a trend toward lower transfusion rates that was not statistically significant. Niskanen at el and Korkala et al conducted a randomized, double-blind study of 39 THA patients that demonstrated smaller total blood loss in cemented THA for patients who received perioperative intravenous TXA. Imai, et al evaluated 107 THA patients who were randomly divided into 1 control group and 4 treatment groups based on the timing of TXA administration. All groups who received TXA, irrespective of the dose timing, experienced lower intraoperative and perioperative total blood loss. Benoni et al, performed a prospective, randomized, double-blind study on the effect of intravenous TXA at the beginning of THA which also demonstrated significantly lower postoperative blood loss compared to placebo. Since indications for allogenic blood transfusions differed among studies, there was no consistent evidence that TXA reduced perioperative transfusion rates.
  1. Martin,J.G.; Cassatt,K.B.; Kincaid-Cinnamon,K.A.; Westendorf,D.S.; Garton,A.S.; Lemke,J.H. Topical administration of tranexamic acid in primary total hip and total knee arthroplasty. J Arthroplasty; 2014/5: 5
  2. Benoni,G.; Fredin,H.; Knebel,R.; Nilsson,P. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand.; 2001/10: 5
  3. Imai,N.; Dohmae,Y.; Suda,K.; Miyasaka,D.; Ito,T.; Endo,N. Tranexamic acid for reduction of blood loss during total hip arthroplasty. J Arthroplasty; 2012/12: 10
  4. Niskanen,R.O.; Korkala,O.L. Tranexamic acid reduces blood loss in cemented hip arthroplasty: a randomized, double-blind study of 39 patients with osteoarthritis. Acta Orthop; 2005/12: 6