Elsevier

The Journal of Arthroplasty

Volume 30, Issue 2, February 2015, Pages 272-276
The Journal of Arthroplasty

Venous Thromboembolism and Mortality Associated With Tranexamic Acid Use During Total Hip and Knee Arthroplasty

https://doi.org/10.1016/j.arth.2014.08.022Get rights and content

Abstract

TKA and THA are associated with blood transfusion and risk for postoperative venothromboembolism (VTE). Reports show that tranexamic acid (TA) may be safe to use in high-risk orthopedic patients, but further data are needed to substantiate its use. All patients who underwent primary or revision TKA or THA in a five year period were retrospectively identified. In 13,262 elective TKA or THA procedures, neither the odds of VTE (OR = 0.98; 95% CI 0.67-1.45; P = 0.939) or adjusted odds of death (OR = 0.26; 95% CI 0.04-1.80; P = 0.171) were significant with TA administration. The major findings of this large, single center, retrospective cohort study show the odds of postoperative VTE and 30-day mortality were unchanged with TA administration.

Section snippets

Material and Methods

After institutional review board approval, the Orthopedic Department Total Joint Registry (TJR) was searched to identify all patients who underwent primary or revision TKA or THA at our institution between January 1, 2005 and January 1, 2010. The TJR is a previously validated and comprehensive repository of data collected for each joint arthroplasty surgery performed at our institution since 1969 [28]. Data included within the TJR have been prospectively defined; and are collected by manual

Results

During the study period, a total of 14,100 cases were initially identified. After exclusions, a total of 13,262 elective TKA or THA procedures in 11,175 unique patients were analyzed (Fig. 1). Patient demographic information is summarized in Table 1. At the time of surgery, 71% of subjects were over the age of 60 (median age 67 years). Tranexamic acid was administered intraoperatively in 2785 procedures (21%).

A total of 196 VTE events were identified for an overall frequency of 1.48%.

Discussion

The primary finding in our large, single institution, retrospective cohort study is that TA administration in TKA and THA did not affect the frequency of VTE within 30 days of surgery. This is consistent with multiple studies currently in the literature, including randomized trials, systematic reviews and meta-analysis 1., 2., 26., 32., 33., 34.. Unfortunately, each of the randomized trials was significantly underpowered to detect a difference in the VTE rate. One recent letter to the editor

Conclusions

This study demonstrates that the overall frequency of clinically-significant VTE was lower when TA was administered, and the odds of postoperative VTE were unchanged. Equally important, no statistically significant change was seen in 30-day mortality, although a trend toward reduced mortality with TA administration was observed. Although these results are encouraging, the exact risks of TA administration for patients undergoing THA and TKA remain unclear and our understanding of the safety of

Acknowledgments

We would like to acknowledge the contributions of Dirk Larson (Mayo Department of Biostatistics) for his assistance with the statistical analysis and preparation of the statistical methods and results sections of manuscript.

References (45)

  • P.K. Wu et al.

    Population-based epidemiology of postoperative venous thromboembolism in Taiwanese patients receiving hip or knee arthroplasty without pharmacological thromboprophylaxis

    Thromb Res

    (2014)
  • A. Shander et al.

    Estimating the cost of blood: past, present, and future directions

    Best Pract Res Clin Anaesthesiol

    (2007)
  • B.R. Levine et al.

    Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial

    J Arthroplasty

    (2014)
  • M. Lozano et al.

    Effectiveness and safety of tranexamic acid administration during total knee arthroplasty

    Vox Sang

    (2008)
  • J.C. Alvarez et al.

    Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied

    Transfusion

    (2008)
  • D.O. Molloy et al.

    Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial

    J Bone Joint Surg Br

    (2007)
  • M.A. Claeys et al.

    Reduction of blood loss with tranexamic acid in primary total hip replacement surgery

    Acta Chir Belg

    (2007)
  • P. Zufferey et al.

    Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?

    Anesthesiology

    (2006)
  • S. Yamasaki et al.

    Tranexamic acid reduces blood loss after cementless total hip arthroplasty-prospective randomized study in 40 cases

    Int Orthop

    (2004)
  • H. Husted et al.

    Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty: a prospective randomized double-blind study in 40 patients

    Acta Orthop Scand

    (2003)
  • M. Veien et al.

    Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study

    Acta Anaesthesiol Scand

    (2002)
  • G. Ekback et al.

    Tranexamic acid reduces blood loss in total hip replacement surgery

    Anesth Analg

    (2000)
  • Cited by (93)

    • Emerging materials for hemostasis

      2023, Coordination Chemistry Reviews
      Citation Excerpt :

      The active hemostats, such as smectite, fibrinogen, and thrombin, can directly activate and accelerate coagulation cascade, accordingly enhancing hemostatic potency in an active pathway.[6,35,36] However, the potential risks of viral contamination, thrombosis, and general or systemic emboli have hindered the wide applications of these active hemostats in various conditions.[37–39] In contrast to the active hemostatic materials, the passive hemostats including sponges, foams, hydrogels, and cryogels mostly function via extracting fluid from blood to concentrate red blood cells (RBCs) as well as platelets, blocking off or sealing bleeding sites.[34,40–42]

    • Blood Management Following Total Joint Arthroplasty in an Aging Population: Can We Do Better?

      2022, Journal of Arthroplasty
      Citation Excerpt :

      Its safety and efficacy have however previously been demonstrated by multiple studies, and appear to outweigh possible adverse events [48–50]. Previous studies suggest no increased VTE rates for patients with history of VTE or ASA ≥3 [51–53]. Although this study did not primarily focus on assessment of TXA safety, VTE rates within this study were not significantly higher in patients who received TXA.

    View all citing articles on Scopus

    Financial Support: Mayo Clinic Departments of Anesthesiology and Orthopedic Surgery.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.08.022.

    View full text