Venous Thromboembolism and Mortality Associated With Tranexamic Acid Use During Total Hip and Knee Arthroplasty
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)
- et al.
The use of tranexamic acid to reduce blood loss during total knee arthroplasty
Knee
(2003) - et al.
Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty
Br J Anaesth
(1995) - et al.
Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest
(2008) Strategies for minimizing blood loss in orthopedic surgery
Semin Hematol
(2004)- et al.
Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty
J Arthroplasty
(2013) - et al.
Effectiveness of oral tranexamic acid administration on blood loss after knee artroplasty: a randomized clinical trial
Transfus Apher Sci
(2013) - et al.
Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: a systematic review of randomized trials
Thromb Res
(2009) - et al.
Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis
Knee
(2013) - et al.
A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty
J Surg Res
(2013) - et al.
Antifibrinolytic agents in current anaesthetic practice: use of tranexamic acid in lower limb arthroplasty
Br J Anaesth
(2014)
Population-based epidemiology of postoperative venous thromboembolism in Taiwanese patients receiving hip or knee arthroplasty without pharmacological thromboprophylaxis
Thromb Res
Estimating the cost of blood: past, present, and future directions
Best Pract Res Clin Anaesthesiol
Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial
J Arthroplasty
Effectiveness and safety of tranexamic acid administration during total knee arthroplasty
Vox Sang
Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied
Transfusion
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
Reduction of blood loss with tranexamic acid in primary total hip replacement surgery
Acta Chir Belg
Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery?
Anesthesiology
Tranexamic acid reduces blood loss after cementless total hip arthroplasty-prospective randomized study in 40 cases
Int Orthop
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
Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized, controlled study
Acta Anaesthesiol Scand
Tranexamic acid reduces blood loss in total hip replacement surgery
Anesth Analg
Cited by (93)
Updated Clinical Review: Perioperative Use of Tranexamic Acid in Orthopedics and Other Surgeries
2023, Advances in AnesthesiaEmerging materials for hemostasis
2023, Coordination Chemistry ReviewsCitation 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 ArthroplastyCitation 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.
A single dose of tranexamic acid reduces blood loss after reverse and anatomic shoulder arthroplasty: a randomized controlled trial
2021, Journal of Shoulder and Elbow Surgery
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.