Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty

Abstract

Category: Ankle; Other Introduction/Purpose: Tranexamic acid (TXA) has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty (TAA). In light of expanding indications for TAA and its growing utilization, there is a need for more data regarding interventions such as TXA that may reduce perioperative complications and improve patient outcomes for this procedure. The purpose of the current study was to determine if the use of TXA in patients undergoing total ankle arthroplasty impacts the blood loss or overall complication rate. Methods: A retrospective chart review was conducted for 34 patients who underwent TAA with (n=17) and without (n=17) intraoperative TXA from 2016 to 2019 at a single academic medical center. Inclusion criteria were patients who underwent TAA for any clinical indication and had quantified intraoperative blood loss. Patients were excluded if they had a contraindication to TXA (ie. impaired renal function), a history of coagulopathy, no recorded intraoperative blood loss, or intraoperative complications that resulted in excessive bleeding. Estimated blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss and complication rates were recorded and compared between groups. Statistical analysis was performed using SPSS 21.0. Results: There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference or hidden blood loss between the groups (all, p>0.05). A lower rate of wound complications was observed in the TXA group. The difference between the overall complications rates observed for each group was not statistically significant (p>0.05). Conclusion: Intravenous tranexamic acid did not result in decreased blood loss during TAA, as measured in our study. However, tranexamic acid was not associated with any increase in overall complications while a lower rate of wound complications was seen in patients in which TXA was utilized. Based on our findings, further studies are needed to better elucidate the impact of TXA on blood loss and wound healing in TAA. [Table: see text]

Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

“…This comes to a significant importance in foot and ankle procedures with high risk of wound complications such as open reduction and internal fixation of calcaneal fractures and total ankle arthroplasty (TAA). 8,26 In this meta-analysis, TXA was associated with lower overall wound complications: 7% compared with 11% in the control group. Unfortunately, we could not perform a direct comparative subanalysis of wound complications because of the low incidence and variability in reported data.…”

“…In a retrospective study by Steinmetz et al 22 that included 119 patients who underwent total ankle arthroplasty, there was no difference in intraoperative blood loss between TXA and control groups. Similarly, a retrospective chart review by Ghobrial et al 8 found that total amount of calculated blood loss did not differ between the treatment and control group ( P > .05). On the contrary, Nodzo et al 16 reported that drain output was significantly less in TXA group compared to that of control group (71.6 ± 60.3 vs 200.2 ± 117.0 mL, respectively, P < .0001).…”

Response to “Letter Regarding: Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis”

“…The PRISMA guidelines state that all systematic reviews should include unpublished literature to avoid positive outcome bias. Therefore, we believe that the inclusion of the abstract by Ghobrial et al 1 in our study was valid and adherent with guidelines and did not introduce a substantial bias. Ultimately, we feel the inclusion of these studies in our analysis mildly increased the bias of the study but did not impact the overall findings significantly.…”

Letter Regarding: Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

“…A lack of a control group severely limits the study’s validity due to the unelimination of the placebo effect. The inclusion of the non–peer-reviewed abstract of Ghobrial et al 3 may be a methodological disadvantage with a potential source of bias. The result of hemoglobin (Hgb) changes in this meta-analysis was greatly influenced by this article’s finding as an outlier, which is assumed to lead to concluding no significant improvement in Hgb levels in the TXA group.…”