Abstract: ObjectiveTo investigate the efficacy and safety of sequential therapy of tranexamic acid (TXA) and anticoagulants for patients who initially underwent total hip arthroplasty (THA). MethodsSixty-four patients initially undergoing total hip arthroplasty were randomly divided into two groups: a test group (n=34) and a control group (n=30). The test group was intravenously injected with 15 mg/kg TXA 10 min (ivgtt) before replacement and infused with 1 g TXA in 20 ml normal saline after incision suturing and kept for 2 h. The control group was not treated with TXA. Furthermore, all patients first received low molecular weight heparin (LMWH) 6 h after surgery if the drainage volume was less than 30 ml/h or at least 12 h after surgery if the drainage volume was over 30 ml/h. LMWH was then used every 24 h. The two groups were compared for the total volumes of blood loss (dominant and hidden blood loss) in the perioperative period, blood transfusion rate, and the incidence of deep vein thrombosis and pulmonary embolism. ResultsThe test group showed remarkable decreases in the total volumes of perioperative blood loss, the hidden blood loss and the blood transfusion rate compared with the control group (P<0.05). No significant difference was found in the incidence of vein thrombosis between the two groups (P>0.05). ConclusionsThe intravenous and local administration of TXA and sequential use of anticoagulants is a safe and effective approach for patients initially undergoing total hip arthroplasty, which can reduce the total volume of perioperative blood loss and blood transfusion rate, without any impact on the incidence of deep vein thrombosis.