Precision-guided tranexamic acid administration in total hip arthroplasty: integrating viscoelastic testing and patient risk stratification into perioperative hemostasis – a narrative review

BACKGROUND: Total hip arthroplasty (THA) is linked to considerable hemorrhage. Although tranexamic acid (TXA) lowers the risk of transfusion, its widespread use may have adverse side effects, particularly in individuals with prothrombotic conditions or renal impairment. New technologies, such as patient-specific stratification and viscoelastic testing [like rotational thromboelastometry (ROTEM)], are designed to enhance the use of TXA. GOALS: The purpose of this study is to assess the effectiveness, safety, and potential application of a precision-based TXA approach in THA that integrates personalized risk assessment and real-time hemostatic monitoring. METHODS: The study employed an overview of post-2021 literature to investigate the pharmacokinetic, immunologic, and hemostatic profiles of TXA in THA. Risk-based dosage adjustments and ROTEM-guided algorithms received particular attention. RESULT: There is proof that customized TXA procedures, directed by risk scores, renal function evaluations, and viscoelastic assays, can maximize bleeding control without raising the risk of thromboembolic or infectious consequences. CONCLUSION: In selected low-risk primary THA populations, oral regimens demonstrate non-inferiority. Transfusion and antifibrinolytic methods can be improved with the use of ROTEM. There is a need for a change in THA treatment towards precise TXA delivery. ROTEM can be used to reduce problems and customize perioperative therapy when combined with renal and thrombotic profiling.