Role of perioperative tranexamic acid in patients with coagulopathy of chronic liver disease undergoing total hip replacement

Background Patients with coagulopathy of chronic liver disease are more vulnerable to the risk of bleeding during surgery. The role of fresh-frozen plasma (FFP) in reversing conventional coagulative tests may be uncertain in such patients. This study evaluates the impact of tranexamic acid (TA) on FFP and blood transfusion requirements during major orthopedic surgery in cirrhotic liver patients.Patients and methods Forty-eight patients (age 50–70 years) with chronic liver disease undergoing total hip replacement were randomized to one of two groups. In the TA group, patients received10 mg/kg of TA diluted in 50 ml saline and administered by infusion over 15 min 2 h before surgery and another dose during the first hour of surgery. In the control group, patients received equal volumes of normal saline. Patients’ characteristics, laboratory investigations, volume of blood loss, number of patients who received FFP and blood transfusion, number of units transfused as well as perioperative complications were recorded. Results Patient characteristics and laboratory results were comparable between the two groups. Percentage of candidates who received FFP and number of FFP units were significantly higher in the control group [75% and 2 (1–2) U] than in the TA group[41.7% and 0 (0–2) U] (P= 0.039 and 0.020, respectively). Volume of blood loss and blood units transfused in the TA group [680 ± 170 ml and 0.5 (0–2) U] were significantly lower than those in the control group [1060± 220 ml and 2 (1–2) U] (P = 0.0001 and 0.018, respectively). No significant difference in postoperative complications was recorded. Conclusion Perioperative administration of TA in patients with chronic liver disease is safe and reduces the need for FFP and blood transfusion during total hip replacement.