Effects of tranexamic acid on blood loss during total hip arthroplasty.

PURPOSE: To assess the effects of tranexamic acid (TA) in patients undergoing total hip arthroplasty (THA) for osteoarthritis. METHODS: 42 patients underwent primary THA for osteoarthritis by a single surgeon. 10 men and 11 women who did not receive TA were controls, whereas 9 men and 12 women who received TA constituted the treatment group. Both groups were matched for age, gender, body mass index, and American Society of Anesthesiologists grading. The type of prosthesis used (cemented or uncemented) was based on the surgeon's preference and patient age, activity level and demands. No hybrid prosthesis was used. 10 minutes prior to incision, a single dose of intravenous TA (10 mg per kg body weight) was given to patients in the treatment group. Comparison was made between both groups with regard to intra-operative blood loss, postoperative reduction in haemoglobin and haematocrit levels, blood transfusion, incidence of deep vein thrombosis, and the length of hospital stay. RESULTS: The mean intra-operative blood loss (489 [SD, 281] vs. 339 [SD, 184] ml, p = 0.048) and the decrease in haemoglobin level (38 [SD, 12] vs. 29 [SD, 10] g/l, p=0.014) were significantly higher in the control than the treatment group. Two patients among the controls received a transfusion, compared to none in the TA group (p = 0.49, Fisher's exact test). The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml, compared to a mean of 489 ml in the whole group. No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months. CONCLUSION: A single dose of intravenous TA (10 mg per kg body weight) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.

Endoscopic diagnosis of gallstone ileus of the duodenum.

Two patients with duodenal obstruction resulting from erosion of a gallstone through the wall of the gallbladder and into the duodenum are described. Both cases were diagnosed endoscopically and successfully treated by a one-stage procedure to remove the obstruction and gallbladder and to close the fistula without complication.