TXA Safe, Effective in Reducing Blood Loss in Joint Replacement Surgery

Tranexamic acid (TXA) has been shown to be safe and effective in reducing blood loss and transfusion rates in joint replacement surgery, according to research presented at the American Academy of Orthopaedic Surgeons (AAOS) 2016 Annual Meeting in Orlando, Florida.

“We launched the study, as conflicting results have been published regarding the use of TXA in patients undergoing hip and knee replacement,” Geoffrey Westrich, MD, director of research in the Adult Reconstruction and Joint Replacement Service at the Hospital for Special Surgery, said in a statement. “There was also concern regarding a potential increased risk of a blood clot, although previous studies have shown this drug to be safe.”

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To examine the safety and effectiveness of TXA in primary unilateral, bilateral, and revision hip and knee arthroplasty, the researchers retrospectively reviewed records from 4449 patients who had hip or knee replacement from November 2013 to May 2014. Of those patients, 720 received TXA topically, 636 received TXA intraveniously, and 3093 received no TXA.

The researchers found TXA to be safe and effective, reducing the need for a blood transfusion by more than 50%.

Of the patients who received TXA, 9.7% received a blood transfusion compared with 22.1% of patients who did not receive TXA. Patients who received TXA received an average of 0.13 units of blood compared with 0.37 units of blood for those who did not receive TXA.

While Dr Westrich noted that intravenous TXA should not be used in patients who have had a previous blood clot or in those who have a cardiac stent, the researchers found no significant difference in effect between intravenous and topical TXA; in those who could not receive intravenous TXA, topical TXA was just as effective.

The chances of a patient who received TXA developing a hospital-acquired venous thromboembolism was 1.63 (95% confidence interval [CI], 0.72-3.69) compared with the odds of patients who did not receive TXA, but this was not statistically significant (P=.24). The researchers did find a statistically significant increase in deep venous thromboembolism with the use of TXA (P=.03) but not pulmonary embolism (P=.94).

“At our institution, TXA in either intravenous or topical form was effective in decreasing the amount of blood transfusions, as well as the number of units of blood transfused in primary and revision hip and knee replacement,” Dr Westrich said in a statement.

“Furthermore, when safety was evaluated, there was no statistically significant increase in venous thrombotic events in this patient population as a group, although there was a slight increase in deep venous thromboembolism, but not pulmonary embolism,” the researchers wrote.

More studies are needed comparing various doses and combining IV and topical TXA in order to determine what would provide patients with the greatest benefit, Dr Westrich concluded.

Reference

Kao YJ, Prashker BL, Westrich GH. Topical versus intravenous tranexamic acid in hip and knee arthroplasty: efficacy and safety. Presented at: 2016 meeting of the American Academy of Orthopaedic Surgeons. March 1-5, 2016; Orlando, Florida. Presentation P101.