To explore the effect of tranexamic acid (TXA) on the rate of transfusion and postoperative complications during the primary unilateral total hip arthroplasty (THA).

The patients who underwent the primary unilateral THA from January 2010 to December 2018 were retrospectively analyzed. Inclusion criteria: the patients accept primary unilateral THA with uncemented prothesis, with primary normal coagulation function, diagnosis of the hip joint are osteoarthritis, ischemic or aseptic necrosis of the femoral head, developmental dysplasia of the hip joint, femoral neck fracture, rheumatoid arthritis and ankylosing spondylitis, receiving 15 mg/kg TXA before skin incision. Exclusion criteria: the patients accept revision or other surgical procedures, with preoperative abnormal coagulation function, the patients with malignant tumors, history of myocardial infarction or lower limb thrombosis, using cement prosthesis, not receiving 15 mg/kg TXA before skin incision, ect. In the postoperative anticoagulants group, 556 patients received TXA, 244 patients did not take TXA as control. In the non-postoperative anticoagulants group, 248 patients received TXA, while 130 patients did not take TXA as control. The primary outcomes were transfusion rate and the maximum loss of hemoglobin (HB). Secondary outcomes included volume of red blood cell (RBC) transfusion, complications and postoperative length of stay. Independent t test, Wilcoxon test and chi-square test were applied for data analysis.

For the patients who underwent primary unilateral THA and administrated anticoagulants postoperatively, the blood transfusion rate of the experimental group was 14.4% and that of the control group was 48.4%, the difference was statistically significant (χ²=105.085, P<0.001). The amount of RBC in the experimental group was lower than that in the control group (2.0 U vs 2.5 U, Z =-2.600, P<0.01) (1 U =200 ml). The maximum loss of HB in the experimental group was lower than that in the control group(32.00 g/L vs 36.29 g/L, Z =-4.402, P<0.001). The ecchymosis around incisions in the experimental group(zero case) was lower than that in the control group(five cases)(P<0.05). There was no significant difference in other complications of incisions and thrombosis events (P>0.05). There was no statistically significant difference in postoperative hospital stay between the experimental group and the control group (P>0.05). For patients who underwent primary unilateral THA and administrated no anticoagulants postoperatively, the blood transfusion rate in the experimental group was lower than that in the control group (9.7% vs 53.8%, χ²=89.058, P<0.001). There was no statistically significant difference between the amount of RBC in the experimental group and the control group (3.5 U vs 4.0 U, Z =-0.303, P>0.05), and the maximum loss of HB in the experimental group(29.82 g/L) was lower than that in the control group (39.48 g/L)(Z =-6.285, P<0.001). Wound infection in the experimental group(one case) was lower than that in the control group(five cases) (P<0.05). There was no statistically significant difference in other wound complications and thrombosis events (P>0.05). Postoperative hospital stay in the experimental group(7 d) was lower than that in the control group (8 d) (Z=-6.165, P<0.001).

TXA can reduce the rate of transfusion and the maximum loss of HB in primary unilateral THA with postoperative anticoagulants administrated or not, and it would not increase postoperative complications of incision and thrombosis, which shows effective hemostasis and safety.