Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

Abstract

<p class="abstract"><strong>Background:</strong> Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.</p><p class="abstract"><strong>Methods:</strong> We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).</p><p class="abstract"><strong>Conclusions:</strong> TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.</p>

Effect of Tranexamic Acid on Blood Management during a High Tibial Osteotomy: A Systematic Review and Meta‐analysis

“…Few studies have reported a correlation between sex and TXA use during a HTO. However, a similar correlation has been reported in spinal surgery, 30 , 31 arthroplasty replacement, 32 , 33 , 34 and orthognathic surgery. 35 Hypotheses for the possible mechanisms are as follows.…”

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

“…Both Viegas et al and Meng et al in studies from 2020 and 2018, respectively, demonstrated that using TXA in patients with higher BMI would result in smaller blood losses when compared with TXA usage in patients with smaller BMIs. 18,30 Higher BMI is associated with higher values of plasminogen activator inhibitor-1 (PAI-1), [30][31][32][33] a protein synthesized by the endothelium, liver, and adipocytes. 31,33,34 PAI-1 prevents the conversion of plasminogen to plasmin and subsequently produces antifibrinolytic effects.…”

“…5,10 Patient-specific instrumentation (PSI) emerged in the last two decades as an alternative to CI, aiming to improve accuracy and cost effectiveness in daily use, as well as reduce operating times, and blood loss caused by TKA. 1,3,5,8,12,13 TKA frequently presents perioperative blood losses, due to soft-tissue dissection and bone cuts, [14][15][16][17][18] estimated between 1,500 and 2,000 mL, with a predictable decrease of 3 g/dL of hemoglobin (Hb) for every 1,000 mL of blood loss. 12,19 Blood loss increases morbidity, mortality and dissatisfaction of patients but it also prolongs hospital admission and increases costs.…”

“…16,[24][25][26][27] Recent studies have concluded that individual characteristics influence TXA action on TKA differently, presenting worse results in terms of blood loss in patients with lower body mass index (BMI). 18,29 As current evidence suggests that both PSI and TXA individually reduce blood loss in TKA, it would be assumed that, when combined, these would result in the least possible blood loss. However, this was not the case in our clinical practice which showed mixed results.…”

Letter to editor regarding “The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis”

“…The results suggested female might benefit more than male on blood management from TXA. Some studies in arthroplasty replacement [ 3 – 5 ] and orthognathic surgeries [ 6 ] presented similar actions. Although the mechanism was still elusive, some hypotheses were given.…”