Clinical study on the reduction of perioperative blood loss in primary total hip arthroplasty by local application of hemocoagulase bothrops atrox for injection: a randomized controlled trial

Abstract Objective The purpose of the study was to investigate the hemostatic effect of local application of 10 units hemocoagulase bothrops atrox for injection (HBA)during the perioperative period of primary total hip arthroplasty (THA). Methods 105 patients who were scheduled to undergo primary THA in the Orthopedics Department of West China Hospital between May 2024 and May 2025 were selected. The participants were randomly divided into the HBA group, the tranexamic acid group(TXA)and the control group, with 35 cases in each. The trial group received an intraoperative local application of 10 units of HBA, the TXA group received 2 g of TXA locally in the surgical area, the control group used an equal amount of normal saline during the operation.Additionally, three groups received 20 mg/kg tranexamic acid intravenously in 100 ml of 0.9% sodium chloride solution over 30 min preoperatively. Various parameters including perioperative hemoglobin decrease, total blood loss, inflammation markers, blood transfusion requirements, VAS scores and Harris Hip Score (HHS) at 1 week, 1 and 3 months, surgical duration, and Compared the adverse events of the three groups of patients. Results There was a significant difference in total blood loss among the three groups of patients. Among them, the HBA group had the least blood loss(P < 0.05). Furthermore, the HBA group demonstrated reduced levels of inflammatory markers CRP and IL-6 on days 1 and 3 post-operation, indicative of a diminished inflammatory response compared to the other groups (P < 0.05). Functional assessments on the 7th day post-surgery revealed significantly lower VAS scores and higher HHS in the HBA group.Notably, No adverse events such as thrombosis were reported in any of the three groups of patients. Conclusion The localized administration of HBA in conjunction with preoperative intravenous TXA demonstrates a good hemostatic efficacy. Compared with the other groups, the HBA group can reduce the early postoperative inflammatory indicators. Level of evidence Therapeutic Level I.