Perioperative application of two hemostatic agents in total hip arthroplasty

doi:10.3877/ cma.j.issn.1674-134X.2025.01.002

Abstract

Abstract:

Objective

To comparative analyze the safety and efficacy of tranexamic acid (TXA) alone versus TXA combined with fluid gelatin in total hip arthroplasty (THA).

Methods

A total of 245 patients with femoral neck fractures, admitted to the Third Hospital of Mianyang from January 2021 to December 2022, were included in this study.Inclusion criteria: patients with unilateral femoral neck fractures who underwent total hip arthroplasty.Exclusion criteria: hematological diseases or other conditions affecting coagulation function, history of hip surgery, or allergies to tranexamic acid or the raw materials of fluid gelatin (derived from pig skin).The patients were divided into two groups: the tranexamic acid group with 130 cases and the fluid gelatin group with 115 cases, based on whether they received co-administration with fluid gelatin.The perioperative blood loss,blood routine, and D-dimer levels were compared between the two groups on the day before surgery, the first day after surgery, and the third day after surgery.Independent sample t test was employed for comparisons between the two groups, while repeated measures ANOVA was performed to analyze changes in complete blood count and D-dimer levels at multiple time points in both groups.

Results

On the third day after surgery, the hemoglobin and hematocrit levels in the fluid gelatin group were significantly higher than those in the TXA group (hemoglobin:t=5.54, P<0.001; hematocrit: t=5.65, P<0.001).The rates of hemoglobin and hematocrit decreases in the fluid gelatin group were lower compared to the TXA group, with statistically significant differences (hemoglobin decrease rate: t=4.37, P<0.001; hematocrit decrease rate: t=6.36, P<0.001).The total blood loss in the fluid gelatin group (543.8±252.9) ml was less than (797.1±357.5) ml in the TXA group.The hidden blood loss in the fluid gelatin group (490.5±252.3) ml was lower than (742.8±353.3) ml in the tranexamic acid group,with statistically significant differences (t=6.32, t=6.35, P<0.001).The blood transfusion rate in the fluid gelatin group was 2.6%, and the rate in the tranexamic acid group was 9.2%, showing statistically significant difference (χ²=3.88, P=0.04).There was no statistically significant difference in the incidence of postoperative deep vein thrombosis between the two groups (P>0.05).

Conclusion

The combined use of TXA and fluid gelatin can effectively reduce perioperative bleeding and decrease the need for postoperative blood transfusions compared to the use of TXA alone, without increasing the incidence of postoperative deep vein thrombosis in patients.

Key words: Tranexamic acid, Arthroplasty, replacement, hip, Hemostatics

Zhixiang Gao, Chao Zhao, Kai Yao, Wei Yu, Lijuan Liu, Le Jia, Xiangdong Kong, Cong Xiao. Perioperative application of two hemostatic agents in total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 7-12.

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Figures/Tables 5

Table 1 Comparison of general data

组别Groups	例数Number of cases	性别（例） Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	部位（例）Side
组别Groups	例数Number of cases	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	左 Left	右Right
流体明胶组Fluid gelatin group	115	58	57	70±14	23±4	68	47
氨甲环酸组TXA group	130	67	63	70±14	23±3	71	59
统计值Statistical values		χ ²=0. 03		t=0. 08	t=0. 86	χ ²=0. 51
P值		>0. 05		>0. 05	>0. 05	>0. 05

Table 1 Comparison of general data

组别Groups	例数Number of cases	性别（例） Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	部位（例）Side
组别Groups	例数Number of cases	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	BMI［kg/m²，（x±s）］	左 Left	右Right
流体明胶组Fluid gelatin group	115	58	57	70±14	23±4	68	47
氨甲环酸组TXA group	130	67	63	70±14	23±3	71	59
统计值Statistical values		χ ²=0. 03		t=0. 08	t=0. 86	χ ²=0. 51
P值		>0. 05		>0. 05	>0. 05	>0. 05

Table 2 Perioperative hemoglobin changes of the two groups

组别Groups	例数Number of cases	术前1 d（g/L）One day before surgery	术后第1天（g/L）First day after surgery	术后第3天（g/L）Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	124±16	110±15^a	108±13^ab	12±7
氨甲环酸组TXA group	130	122±16	106±16^a	98±13^ac	19±12
t 值		0. 94	1. 81	5. 54	4. 37
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

Table 3 Perioperative hematocrit changes of the two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery	术后第3天下降率(%)Decline rate on third day after surgery
流体明胶组Fluid gelatin group	115	37±4	33±4^a	32±3^a	14±7
氨甲环酸组TXA group	130	37±4	32±4^a	29±4^ab	20±8
t 值		0. 47	1. 51	5. 65	6. 36
P值		>0. 05	>0. 05	＜0. 001	＜0. 001

Table 4 Blood loss and transfusion rates in two groups

组别Groups	例数Number of cases	TBL ［ml，（x±s）］	HBL ［ml，（x±s）］	输血率［例（%）］ Blood transfusion rate
流体明胶组Fluid gelatin group	115	543. 8±252. 9	490. 5±252. 3	3/112（2. 6）
氨甲环酸组TXA group	130	797. 1±357. 5	742. 8±353. 3	11/119（9. 2）
统计值Statistical values		t=6. 32	t=6. 35	χ ²=3. 88
P值		＜0. 001	＜0. 001	0. 04

Table 5 Perioperative D-dimer comparison between two groups

组别Groups	例数Number of cases	术前1 dOne day before surgery	术后第1天First day after surgery	术后第3天Third day after surgery
流体明胶组Fluid gelatin group	115	10. 4±4. 3	4. 1±4. 0^a	2. 5±2. 0^ab
氨甲环酸组TXA group	130	10. 6±18. 1	4. 7±4. 7^a	3. 0±3. 0^ab
t 值		0. 09	1. 02	1. 15
P值		>0. 05	>0. 05	>0. 05

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