Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial.

BACKGROUND: Tranexamic acid (TXA) reduces perioperative blood loss in total hip arthroplasty (THA). METHODS: In our randomized control trial, 139 patients were enrolled and received 2 g of either topical or intravenous (IV) TXA. Preoperative and postoperative protocols were standardized. RESULTS: Calculated blood and Hgb loss were lower in the IV group (1195.0 ± 485.9 mL, 1442.7 ± 562.7 mL; P = .006), (160.3 [g] ± 63.8, 188.4 [g] ± 68.5; P = .014). There was a trend toward significance in transfusion reduction (11% [IV] vs 18% [topical]; P = .3). Both groups effectively reduced the transfusion rate. There was significant financial incentive for the use of TXA in THA with a savings of $314 per patient. CONCLUSIONS: IV and topical TXA are effective tools to reduce blood loss and transfusion costs in THA, and we recommend the IV form for ease of use