gms | German Medical Science

Objectives: The perioperative blood loss during total hip arthroplasty can be a serious problem in the postoperative period. Postoperative anemia complexes the rehabilitation of the patient and is associated with an increase in the incidence of various complications. The reduction of perioperative blood loss allows to eliminate the need for blood transfusion and to improve the results of the following treatment. The inhibitors of fibrinolysis are successfully used in orthopedic practice, however, the choice of the corresponding drug and the optimal method of administration is still widely discussed. The aim of the study was to evaluate the efficiency, safety and costs of combined use (intravenous and intra-articular) of tranexamic (TXA) and aminocaproic acid (ACA) in reducing perioperative blood loss during THA

Methods: A prospective, comparative, randomized clinical trial study was conducted involving 114 patients with hip osteoarthritis who had undergone primary unilateral THA. Patients in the study group (57) received ACA (50 mg/ml solution) in an administered dose of 100 mg/kg (intravenous) before the surgery and 1 g (intra-articular) administration at the end of surgery. Patients in the control group (57) received TXA in doses of 15 mg/kg (intravenous) before the surgery and 1 g dissolved in 20 ml saline solution (intra-articular) at the end of the surgery. The total blood loss, difference in the reduction of hemoglobin concentration (preoperative and on the fifth day postoperatively), blood transfusions rates and costs were estimated. Statistica 10.0 software was used for statistical analysis. In the case of a normal distribution the Student's t-test was used and the data present as the mean [standard deviation]. The nonparametric data were presented as the mean [confidence interval 95%] and the Mann-WhitneyU-test was used for analysis. A statistic significance level of p<0,05 was taken.

Results: Total blood loss was 924 [125] ml in the study group and 877 [154] ml in the control group (P>0.05). There was no significant difference in the reduction of hemoglobin concentration between study 2.7 [2.3-2.9] and control group 2.5 [2.1-2.8] (P>0.05).At our hospital, mean costs for ACA /patient are 1.2 Euro and TXA/patient are 21.5 Euro. All in all the costs made 68.4 Euro for the patients of the study group and 1226.5 Euro for the control group. None of the patients received blood transfusion. There were no clinically detected venous thromboembolic events.

Conclusion: Combined application of inhibitors of fibrinolysis is an effective and safe method of reducing perioperative blood loss. However, the use of ACA is accompanied by lower economic costs