A total of 124 patients scheduled for THA were consecutively randomized 1:1:1 into three parallel arms: control (placebo), 10 mg/kg IV-TXA and 15 mg/kg IV-TXA.
The proportion of patients who experienced bleeding and required transfusions was significantly lower in the 15 mg/kg IV-TXA group (1 of 42, 2.4%) than in the 10 mg/kg IV-TXA group (8 of 39, 20.5%; P = 0.012) and in the control group (10 of 38, 26.3%; P = 0.002). In fact, this proportion was similar between the 10 mg/kg IV-TXA and control groups (P = 0.547). Ultrasound examination on postoperative day 3 revealed only one case of asymptomatic deep vein thrombosis (in the femoral vein) in the 10 mg/kg IV-TXA group, which was managed by administering low-molecular-weight heparin. No cases of deep-vein thrombosis were observed in the other two groups. No cases of symptomatic pulmonary embolism were observed.
IV-TXA at 10 mg/kg significantly reduced blood loss and mitigated the decrease in hemoglobin and hematocrit after THA, but it did not significantly reduce the need for transfusions. In contrast, a dose of 15 mg/kg reduced both bleeding and transfusion requirements. Our results argue for a dose of 15 mg/kg when using single-dose IV-TXA.
Therapeutic Level I
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