Abstract
Background
Tranexamic acid (TXA) administration to reduce postoperative blood loss and transfusion
is a well-established practice for total knee arthroplasty (TKA) and total hip arthroplasty
(THA). However, clinical concerns remain about the safety of TXA in patients with
a history of a prothrombotic condition. We sought to determine the risk of complications
between high-risk and low-risk TKA and THA patients receiving TXA.
Methods
We retrospectively reviewed 38,220 patients (8877 high-risk cases) who underwent primary
TKA and THA between 2011 and 2017 at our institution. Intravenous TXA was administered
in 20,501 (54%) of cases. The rates of thrombotic complications (deep vein thrombosis
[DVT], pulmonary embolism [PE], myocardial infarction [MI], and cerebrovascular accident
[CVA]) as well as mortality and readmission were assessed at 90 days postoperatively.
Additionally, we evaluated 90-day postoperative occurrence of DVT and PE separate
from occurrence of MI and CVA. Patients were categorized as high risk if they had
a past medical history of a prothrombotic condition prior to surgery.
Results
There was no significant difference in the odds of these adverse outcomes between
high-risk patients who received TXA and high-risk patients who did not receive TXA
(odds ratio [OR] 1.00, 95% confidence interval [CI] 0.85-1.18). There were also no
differences when evaluating the odds of 90-day postoperative DVT and PE (OR 0.84,
95% CI 0.59-1.19) nor MI and CVA (OR 0.91, 95% CI 0.56-1.49) for high-risk patients
receiving TXA vs high-risk patients who did not receive TXA.
Conclusion
TXA administration to high-risk TKA and THA patients is not associated with a statistically
significant difference in adverse outcomes. We present incremental evidence in support
of TXA administration for high-risk patients undergoing primary arthroplasties.
Keywords
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Article Info
Publication History
Published online: August 17, 2019
Accepted:
August 5,
2019
Received in revised form:
July 20,
2019
Received:
April 15,
2019
Footnotes
Source of Funding: This work was supported by the Mayo Clinic , United States Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.08.015.
Author Contributions: All authors were responsible for drafting of the manuscript, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. The study has been approved by all authors in the present format.
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