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Efficacy and Safety of Combined Carbazochrome Sodium Sulfonate and Tranexamic Acid for Blood Loss Control in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Document Type : Review Article

Authors

1 Kettering General Hospital NHS Foundation Trust; Kettering, England

2 Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

3 Northwick Park Hospital, Harrow, England, United Kingdom

4 Obstetrics and Gynaecology Specialty Trainee, Diana Princess of Wales Hospital, Grimsby, United Kingdom

5 Internal Medicine Fellowship Trainee, Benha Health Insurance Hospital, Banha, Egypt

6 Faculty of Medicine, Al‐Azhar University, Cairo, Egypt

10.30476/ijms.2025.106924.4124

Abstract

Background: Total hip arthroplasty (THA) relieves pain and restores function in severe hip arthritis and other painful hip disorders. THA is successful; however, it involves significant perioperative blood loss, which can lead to complications and economic burden. Tranexamic acid (TXA) reduces blood loss. However, its impact on hidden blood loss (HBL) is uncertain. The hemostatic effect of TXA may be enhanced by carbazochrome sodium sulphate (CSS). This study aimed to evaluate the safety and efficacy of combined CSS and TXA in reducing blood loss in THA.
Methods: This systematic review and meta-analysis was conducted in accordance with the Cochrane Handbook and PRISMA guidelines. We included randomized controlled trials comparing CSS+TXA versus TXA alone in patients undergoing primary THA. Four electronic databases (MEDLINE via PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception to 22 May 2024 without language restrictions. The risk of bias was assessed using the Cochrane ROB2 tool. Data were synthesized using mean difference (MD) or relative risk (RR) with 95% confidence intervals. Fixed- or random-effects models were applied based on the level of heterogeneity. Outcomes assessed included total (TBL), hidden (HBL), and intraoperative blood loss (IBL); mean hemoglobin (Hb) reduction; inflammatory markers; visual analogue scale (VAS) pain levels; hospital stay; transfusion rates; and complications. 
Results: This analysis included 450 participants from three studies. The meta-analysis revealed that the CSS+TXA group had significantly lower TBL (MD=-270.23 mL; P<0.001) and HBL (MD=-269.09 mL; P<0.001) than the TXA+Placebo group. However, there was no significant difference in IBL (MD=-82 mL; P=0.61). The CSS+TXA group had a lower transfusion rate (RR=0.10; P=0.006). Mean Hb reduction, hospital stay, and operation time were not significantly different. CSS+TXA also significantly reduced postoperative VAS pain and inflammatory markers. There was no increase in thromboembolic events or other complications.
Conclusion: The combination of CSS and TXA reduces postoperative blood loss, pain, and inflammation in patients undergoing THA, without increasing complications. Further research is required to validate these findings in larger, more diverse populations, and to determine optimal dosing and long-term outcomes.

Highlights

Mohamed Wahb (Google Scholar) 

Keywords

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Iranian Journal of Medical Sciences
Volume 51, Issue 3
March 2026
Pages 160-174
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History
  • Received: 05 May 2025
  • Revised: 28 July 2025
  • Accepted: 08 August 2025
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