The combined impact of tranexamic acid protocol and drainage on blood loss in primary total hip arthroplasty a retrospective cohort study

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). 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. 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. 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. This study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500110397, registered on 20251013).