The combined impact of tranexamic acid protocol and drainage on blood loss in primary total hip arthroplasty a retrospective cohort study.
6 affiliations
- 1Department of Orthopaedic Surgery, Yuyao Hospital of Traditional Chinese Medicine, Ningbo, Zhengjiang Province, China.
- 2Department of Orthopaedic Surgery, The Third People's Hospital Health Care Group of Cixi, Ningbo, Zhengjiang Province, China.
- 3The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhengjiang Province, China.
- 4Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhengjiang Province, China.
- 5Ningbo Women and Children's Hospital, The Women and Children's Hospital of Ningbo University, Ningbo, Zhengjiang Province, China.
- 6Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, The 4th Medical College of Peking University, Beijing, China. [email protected].
Abstract
Background
This study evaluated the independent and interactive effects of tranexamic acid (TXA) dosage, timing, and drainage on blood loss in primary total hip arthroplasty (THA).Methods
This retrospective cohort study included 297 patients who underwent primary unilateral THA. Patients were grouped by TXA dosage. The Kruskal‑Wallis H test with post‑hoc analysis compared total blood loss, visible blood loss, hidden blood loss, and hemoglobin drop. Subgroup analysis was stratified by TXA dosage and drainage use. A generalized linear model identified independent predictors and interaction effects, controlling for age, sex, BMI, preoperative hemoglobin, drainage, TXA dosage, administration method, and timing.Results
High‑ and medium‑dose TXA showed better hemostatic effects than no TXA, without increasing DVT/PE incidence (χ² = 4.1, P = 0.186). Drainage use was associated with greater visible blood loss, and higher TXA doses with lower blood loss. In the primary full-cohort model (Table 3), advanced age was identified as an independent predictor of greater blood loss (P < 0.001), while drainage did not reach statistical significance (P = 0.107). In the secondary model restricted to TXA recipients (Table 5), both advanced age (P < 0.001) and drainage (P = 0.03) were significant independent predictors. A significant interaction was found between preoperative intravenous administration and TXA dosage (P = 0.004), but all simple effect pairwise comparisons were non‑significant (all P > 0.05). The comparison between high‑ and medium‑dose TXA showed wide confidence intervals (mean difference + 10.6 mL; 95% CI - 550.3 to 571.5; P = 0.970), indicating substantial uncertainty.Conclusion
Blood loss is influenced by patient factors, drainage, and TXA strategy. Medium‑dose TXA with preoperative IV administration may be a reasonable alternative to high‑dose regimens, though this finding is based on a non‑significant trend. Drainage use was associated with greater visible blood loss and should be carefully reconsidered.Trial registration
This study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500110397, registered on 20251013).
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BibTeX
@article{lu2026combined,
title = {{The combined impact of tranexamic acid protocol and drainage on blood loss in primary total hip arthroplasty a retrospective cohort study.}},
author = {Qiyuan Lu and Mengmeng Chen and Jinsheng Yu and Houfu Ling and Jinbo Huang and Junjun Chen and Lan Lu and Yujiang Mao},
journal = {BMC surgery},
year = {2026},
month = aug,
doi = {10.1186/s12893-026-04108-3},
url = {https://europepmc.org/article/MED/42958176},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The combined impact of tranexamic acid protocol and drainage on blood loss in primary total hip arthroplasty a retrospective cohort study.
AU - Qiyuan Lu
AU - Mengmeng Chen
AU - Jinsheng Yu
AU - Houfu Ling
AU - Jinbo Huang
AU - Junjun Chen
AU - Lan Lu
AU - Yujiang Mao
PY - 2026
DA - 2026/08/03
JO - BMC surgery
DO - 10.1186/s12893-026-04108-3
UR - https://europepmc.org/article/MED/42958176
AB - Background This study evaluated the independent and interactive effects of tranexamic acid (TXA) dosage, timing, and drainage on blood loss in primary total hip arthroplasty (THA).Methods This retrospective cohort study included 297 patients who underwent primary unilateral THA. Patients were grouped by TXA dosage. The Kruskal‑Wallis H test with post‑hoc analysis compared total blood loss, visible blood loss, hidden blood loss, and hemoglobin drop. Subgroup analysis was stratified by TXA dosage and drainage use. A generalized linear model identified independent predictors and interaction effects, controlling for age, sex, BMI, preoperative hemoglobin, drainage, TXA dosage, administration method, and timing.Results High‑ and medium‑dose TXA showed better hemostatic effects than no TXA, without increasing DVT/PE incidence (χ² = 4.1, P = 0.186). Drainage use was associated with greater visible blood loss, and higher TXA doses with lower blood loss. In the primary full-cohort model (Table 3), advanced age was identified as an independent predictor of greater blood loss (P < 0.001), while drainage did not reach statistical significance (P = 0.107). In the secondary model restricted to TXA recipients (Table 5), both advanced age (P < 0.001) and drainage (P = 0.03) were significant independent predictors. A significant interaction was found between preoperative intravenous administration and TXA dosage (P = 0.004), but all simple effect pairwise comparisons were non‑significant (all P > 0.05). The comparison between high‑ and medium‑dose TXA showed wide confidence intervals (mean difference + 10.6 mL; 95% CI - 550.3 to 571.5; P = 0.970), indicating substantial uncertainty.Conclusion Blood loss is influenced by patient factors, drainage, and TXA strategy. Medium‑dose TXA with preoperative IV administration may be a reasonable alternative to high‑dose regimens, though this finding is based on a non‑significant trend. Drainage use was associated with greater visible blood loss and should be carefully reconsidered.Trial registration This study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500110397, registered on 20251013).
SN - 1471-2482
ER -