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Tranexamic acid attenuates early post-operative systemic inflammatory response and nutritional loss and avoids reduction of fibrinogen in total hip arthroplasty within an enhanced recovery after surgery pathway

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Abstract

Purpose

Total hip arthroplasty (THA) is an intervention with significant inflammatory response. The impact of additional doses of tranexamic acid (TXA) on inflammatory response, trauma and nutrition parameters, and coagulation and fibrinolysis changes has rarely been reported.

Methods

A prospective double-blind randomized trial was performed on elective primary THA. Ninety-nine adult patients were recruited consecutively from 2019 to 2020. They were randomized to receive single-dose of TXA before incision, another dose of TXA at three hours post-operatively, or another two doses of TXA at three and six hours  post-operatively. The primary outcomes included changes in white blood cell (WBC) counts, creatine kinase (CK), haemoglobin(Hb), and albumin(Alb); the secondary outcomes included coagulation and fibrinolysis parameters.

Results

Compared with single-dose TXA, patients received three dose TXA had significantly reduced WBC counts and fibrinogen/fibrin degradation product (FDP) levels, increased albumin and fibrinogen levels, and prolonged PT on post-operative day (POD) three. Though patients received three dose TXA had a tendency that increased Hb, decreased CK, reduced D-D, and prolonged APTT on POD3, it is not statistically significant. And the other measured outcomes on POD1 and POD2W shared a similar statistical result, except PT. The PT is significantly prolonged on POD2W in three dose group compared with single dose.

Conclusion

Three-dose TXA contribute to attenuate early post-operative systemic inflammatory response and nutritional loss, increase fibrinogen, reduce FDP levels, and prolong PT in THA patients within an ERAS pathway, which may associate with reduced early post-operative haemorrhagic tendency, thrombosis risks, and hypercoagulability.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Natural Science Foundation of China (grant number 81974333) the Technology R&D Program of Sichuan Province, China (grant number 2019YFS0123); and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18040).

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Author notes

  1. Chen Changjun and Zhao Xin contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People’s Republic of China

    Chen Changjun, Zhao Xin, Luo Yue, Zhao Chengcheng, Wang Qiuru, Li Qianhao & Kang Pengde

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  1. Chen Changjun
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  2. Zhao Xin
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  3. Luo Yue
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  7. Kang Pengde
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Contributions

CJ C and Z X participated in the drafting, writing, and revising of the manuscript. L Y, L BH, L QH, and Z CC participated in the data selection and analysis. PD K participated in the conception and design of the study and contributed to analysis and interpretation of the data, and they approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work.

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Correspondence to Kang Pengde.

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Changjun, C., Xin, Z., Yue, L. et al. Tranexamic acid attenuates early post-operative systemic inflammatory response and nutritional loss and avoids reduction of fibrinogen in total hip arthroplasty within an enhanced recovery after surgery pathway. International Orthopaedics (SICOT) 45, 2811–2818 (2021). https://doi.org/10.1007/s00264-021-05182-3

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