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The objectives of the study were to compare an autologous blood salvage low-vacuum drainage system with a high-vacuum drainage system with regard to blood loss, postoperative hemoglobin levels and need for allogeneic transfusion. The study was an open, randomized, prospective and single-center trial. Two hundred patients scheduled for revision total hip surgery were randomized to either the Bellovac ABT (autologous blood salvage, low vacuum) or the Medinorm AG (high vacuum) drainage system. Blood loss, transfusion volumes and hemoglobin levels were measured during the whole postoperative period. No statistically significant differences were detected between the two drainage systems with regard to transfusion rate, blood loss and adverse events. The hemoglobin decrease during the first postoperative day was statistically significantly less in the Bellovac ABT group (P = 0.0111). Postoperative hemoglobin concentrations were found to be higher in the Bellovac ABT group compared with the Medinorm group at day 1. In addition, the Bellovac ABT system offers a possibility of transfusion of postoperatively salvaged blood that may decrease the need for allogeneic blood transfusion.