Tranexamic Acid in Hip and Knee Arthroplasty

Abstract

Perioperative blood loss is a significant concern for patients undergoing total joint arthroplasty. A growing body of evidence has shown tranexamic acid (TXA) to be effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision hip and knee arthroplasty. TXA is a synthetic drug that limits blood loss through inhibition of fibrinolysis and clot degradation. Both topical and intravenous administration of TXA, in a variety of dosing regimens, has proven effective. Further investigation is required to determine the optimal dose and dosing regimens; however, evidence exists to recommend an initial intravenous dose be given before beginning the procedure, with at least one additional intravenous dose administered postoperatively. Additionally, topical TXA doses >2 g appear to be more efficacious than lower doses. Finally, relatively few adverse reactions have been reported in arthroplasty patients, and no study to date has demonstrated an increased risk of symptomatic venous thromboembolic events in this patient population.

The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty

“…5 High quality evidence from systematic reviews and meta-analyses has supported the use of IV TXA 8 and IA TXA 7 in reducing blood loss and reducing blood transfusion rates without increasing the incidence of thromboembolism complications. Recently, to find the most effective TXA regimen, a new strategy of TXA use - the combined-use strategy - was considered.…”

“…TXA is a synthetic drug that reduces blood loss through inhibition of fibrinolysis and clot degradation. 5 Currently, various dosing regimens have been used for TXA, including intravenous (IV), intra-articular (IA) and oral forms. 6 High quality evidence from systematic reviews and meta-analyses 7,8 have confirmed the efficacy of IV TXA and IA TXA in TKA.…”

Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid

“…While there are more historical studies documenting the efficacy of TXA in reducing blood loss and transfusion requirements [12,13], the literature on the subject has increased dramatically over the past few years [10], as the use of TXA has become nearly universal at centers throughout North America. Studies have shown a low risk of thromboembolic complications with TXA use, even with less aggressive chemoprophylactic regimens using aspirin [14].…”

“…TXA is a synthetic drug which inhibits fibrinolysis and clot degradation and may be administered in intravenous (IV), topical, or oral forms. Numerous studies in recent years have highlighted the effectiveness of TXA in decreasing perioperative blood loss and transfusion requirements without significant risk of adverse events or perioperative thromboembolic phenomena [10]. A recent meta-analysis of RCTs evaluating the effectiveness of TXA in primary TKA showed that, when compared to placebo, TXA reduced blood loss by roughly 500 mL and resulted in 1.43 less units of blood transfused per patient [11].…”

Correspondence to: “Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study”

“…The use of cold compression dressings postoperatively has been shown to significantly reduce blood loss (4) More importantly the use of topical or intravenous tranexamic acid, which has now become a standard in arthroplasty, was not considered in this paper. This has in recent times revolutionized the associated blood loss with such procedures (5,6). Consideration should also be given to varying operative techniques such as early tourniquet release followed by intraoperative achievement of hemostasis, which aim to decrease the associated complications (7).…”