{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:30Z","timestamp":1787754930751,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,4]]},"abstract":"\n Background:<\/jats:title>\n The purpose of this multicenter, randomized trial was to determine the optimal dosing regimen of tranexamic acid (TXA) to minimize perioperative blood loss in revision total hip arthroplasty.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Six centers prospectively randomized 175 patients to 1 of 4 regimens: (1) 1-g intravenous (IV) TXA prior to incision (the single-dose IV group), (2) 1-g IV TXA prior to incision followed by 1-g IV TXA after arthrotomy wound closure (the double-dose IV group), (3) a combination of 1-g IV TXA prior to incision and 1-g intraoperative topical TXA (the combined IV and topical group), or (4) 3 doses totaling 1,950-mg oral TXA (the multidose oral group). Randomization was based on revision subgroups to ensure equivalent group distribution. An a priori power analysis (\u03b1 = 0.05; \u03b2 = 0.80) determined that 40 patients per group were required to identify a >1-g\/dL difference in postoperative hemoglobin reduction between groups. Per-protocol analysis involved an analysis of variance, Fisher exact tests, and two 1-sided t tests for equivalence. Demographic and surgical variables were equivalent between groups.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n No significant differences were found between TXA regimens when evaluating reduction in hemoglobin (3.4 g\/dL for the single-dose IV group, 3.6 g\/dL for the double-dose IV group, 3.5 g\/dL for the combined IV and topical group, and 3.4 g\/dL for the multidose oral group; p = 0.95), calculated blood loss (p = 0.90), or transfusion rates (14% for the single-dose IV group, 18% for the double-dose IV group, 17% for the combined group, and 17% for the multidose oral group; p = 0.96). Equivalence testing revealed that all possible pairings were statistically equivalent, assuming a >1-g\/dL difference in hemoglobin reduction as clinically relevant. There was 1 venous thromboembolism, with no differences found between groups (p = 1.00).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n All 4 TXA groups tested had equivalent blood-sparing properties in the setting of revision total hip arthroplasty, with a single venous thromboembolism reported in this high-risk population. Based on the equivalence between groups, surgeons should utilize whichever of the 4 investigated regimens is best suited for their practice and hospital setting. Given the transfusion rate in revision total hip arthroplasty despite TXA utilization, further work is required in this area.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level I<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.20.00010","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T14:17:55Z","timestamp":1601302675000},"page":"1883-1890","source":"Crossref","is-referenced-by-count":26,"title":["The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2566-1871","authenticated-orcid":false,"given":"Robert A.","family":"Sershon","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Anderson Orthopaedic Research Institute, Alexandria, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6626-9913","authenticated-orcid":false,"given":"Yale A.","family":"Fillingham","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-1724","authenticated-orcid":false,"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2636-9215","authenticated-orcid":false,"given":"Arthur L.","family":"Malkani","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0681-7014","authenticated-orcid":false,"given":"Ran","family":"Schwarzkopf","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New York University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0309-4754","authenticated-orcid":false,"given":"Douglas E.","family":"Padgett","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0999-0648","authenticated-orcid":false,"given":"Thomas P.","family":"Vail","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6149-0777","authenticated-orcid":false,"given":"Denis","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4753-0928","authenticated-orcid":false,"given":"Cindy","family":"Nahhas","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0976-7630","authenticated-orcid":false,"given":"Chris","family":"Culvern","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2913-7513","authenticated-orcid":false,"given":"Craig J.","family":"Della Valle","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Hip Society Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,9,28]]},"reference":[{"issue":"9034","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/S0140-6736(96)04330-9","article-title":"Effect of anaemia and cardiovascular disease on surgical mortality and morbidity","volume":"348","author":"Carson","year":"1996","journal-title":"Lancet."},{"issue":"21","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.2106\/JBJS.N.00128","article-title":"Perioperative blood transfusions in orthopaedic surgery","volume":"96","author":"Ponnusamy","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"21","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.2106\/JBJS.L.00908","article-title":"Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H)","volume":"95","author":"Alshryda","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1302\/0301-620X.96B8.33745","article-title":"A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement","volume":"96-B","author":"Alshryda","year":"2014","journal-title":"Bone Joint J."},{"issue":"7","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1302\/0301-620X.97B7.35029","article-title":"A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty: a prospective randomised double-blind study","volume":"97-B","author":"Hsu","year":"2015","journal-title":"Bone Joint J."},{"issue":"11","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1302\/0301-620X.95B11.31055","article-title":"Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement: results of 3000 procedures","volume":"95-B","author":"Irwin","year":"2013","journal-title":"Bone Joint J."},{"issue":"1","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1302\/0301-620X.93B1.24984","article-title":"Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement","volume":"93","author":"Sukeik","year":"2011","journal-title":"J Bone Joint Surg Br."},{"issue":"5","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"373","DOI":"10.2106\/JBJS.16.00188","article-title":"Oral and intravenous tranexamic acid are equivalent at reducing blood loss following total hip arthroplasty: a randomized controlled trial","volume":"99","author":"Kayupov","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1016\/j.arth.2018.06.023","article-title":"The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis","volume":"33","author":"Fillingham","year":"2018","journal-title":"J Arthroplasty."},{"issue":"10","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"3090","DOI":"10.1016\/j.arth.2018.04.043","article-title":"The efficacy of tranexamic acid in total knee arthroplasty: a network meta-analysis","volume":"33","author":"Fillingham","year":"2018","journal-title":"J Arthroplasty."},{"issue":"10","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"3070","DOI":"10.1016\/j.arth.2018.03.031","article-title":"The safety of tranexamic acid in total joint arthroplasty: a direct meta-analysis","volume":"33","author":"Fillingham","year":"2018","journal-title":"J Arthroplasty."},{"issue":"10","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1016\/j.arth.2018.08.002","article-title":"Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society","volume":"33","author":"Fillingham","year":"2018","journal-title":"J Arthroplasty."},{"issue":"6_Supple_B","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1302\/0301-620X.101B6.BJJ-2018-1376.R1","article-title":"Intravenous tranexamic acid safely and effectively reduces transfusion rates in revision total hip arthroplasty","volume":"101-b","author":"Hines","year":"2019","journal-title":"Bone Joint J."},{"issue":"17","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.2106\/JBJS.17.01212","article-title":"The effect of preoperative administration of intravenous tranexamic acid during revision hip arthroplasty: a retrospective study","volume":"100","author":"Peck","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/1120700018768655","article-title":"Transfusion rate using intravenous tranexamic acid in hip revision surgery","volume":"28","author":"Mariani","year":"2018","journal-title":"Hip Int."},{"issue":"11","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1016\/j.arth.2016.03.059","article-title":"The efficacy and safety of combination of intravenous and topical tranexamic acid in revision hip arthroplasty: a randomized, controlled trial","volume":"31","author":"Wu","year":"2016","journal-title":"J Arthroplasty."},{"issue":"12","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"2850","DOI":"10.1016\/j.arth.2016.05.058","article-title":"Tranexamic acid reduces blood transfusions in revision total hip arthroplasty","volume":"31","author":"Park","year":"2016","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s11999-010-1441-2","article-title":"Tranexamic acid reduces allogenic transfusion in revision hip arthroplasty","volume":"469","author":"Noordin","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"20","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"e920","DOI":"10.5435\/JAAOS-D-18-00205","article-title":"Blood transfusion trends in primary and revision total joint arthroplasty: recent declines are not shared equally","volume":"27","author":"Kimball","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"issue":"7_Supple_C","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1302\/0301-620X.101B7.BJJ-2018-1451.R1","article-title":"2019 Mark Coventry Award: a multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: does the dosing regimen matter?","volume":"101-B","author":"Fillingham","year":"2019","journal-title":"Bone Joint J."},{"issue":"3","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/00000542-198303000-00016","article-title":"Estimating allowable blood loss: corrected for dilution","volume":"58","author":"Gross","year":"1983","journal-title":"Anesthesiology."},{"issue":"2","key":"bib22-20230810","first-page":"224","article-title":"Prediction of blood volume in normal human adults","volume":"51","author":"Nadler","year":"1962","journal-title":"Surgery."},{"issue":"1","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"49","DOI":"10.7326\/0003-4819-157-1-201206190-00429","article-title":"Clinical Transfusion Medicine Committee of the AABB. Red blood cell transfusion: a clinical practice guideline from the AABB*","volume":"157","author":"Carson","year":"2012","journal-title":"Ann Intern Med."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:08Z","timestamp":1787751308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00010"}},"subtitle":["A Multicenter Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2020,9,28]]},"references-count":23,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.00010","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,28]]}}}