Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Tranexamic Acid Administration Is Not Associated With an Increase in Complications in High-Risk Patients Undergoing Primary Total Knee or Total Hip Arthroplasty: A Retrospective Case-Control Study of 38,220 Patients

“…In our review of 38,220 TJA patients, we found that the administration of TXA in high-risk patients was not associated with a statistically significant increased risk of serious postoperative complications, defined as DVT, PE, MI, CVA, death, or readmission at 90 days. Our study gives additional credence to the recent clinical guide on TXA administration in TJA patients, specifically concerning guideline questions 7 and 8 which concern high-risk patients and arterial thromboembolic complications [19]. They found that TXA was not associated with an increase in complications including thromboembolic events (95% CI 0.85-1.02) and renal failure (95% CI 0.70-1.11), though their study did not focus on high-risk patients.…”

“…A recent clinical practice guide from the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopedic Surgeons, Hip Society, and Knee Society reviewed the evidence supporting the use of TXA in TJA [19]. Specifically, the authors stated that in patients with a history of venous thromboembolism (VTE), myocardial infarction (MI), cerebrovascular accident (CVA), transient ischemic attack, and/or vascular stent placement with a concern for arterial thromboembolic events undergoing primary TJA, the existing data do not suggest an increased risk of thromboembolic events when TXA is utilized [19]. The strength of this recommendation was moderate and noted the "paucity of randomized clinical trials" on these subjects.…”

“…The strength of this recommendation was moderate and noted the "paucity of randomized clinical trials" on these subjects. It was also noted that clinical concerns remain when physicians taking care of TJA patients are confronted with a complicated medical history, including prothrombotic states such as patients with a history of MI, CVA, or protein C or S deficiency [19].…”

Effectiveness and safety of tranexamic acid in total joint arthroplasty

“…Similarly, in total hip arthroplasty, IV and topical TXA were found to minimise the need of transfusion by 60% and 71%, respectively compared to placebo. Fillingham et al (2018), however, concluded that oral TXA in total hip arthroplasty did not significantly reduce the risk of blood transfusion compared to placebo. Stoicea et al (2018) concluded in their study that the use of 1–2 gram of TXA (IV or intra-articular [IA]) significantly decreased the drop in Hb postoperatively, and did not increase the risk of adverse events.…”

“…In a published study by Fillingham et al (2018), a meta-analysis looked into 1 moderate quality and 82 high quality studies on TXA, suggesting that the use of intravenous (IV), topical, and oral TXA to be an effective strategy in reducing blood loss and the need for blood transfusion in TJA. The risk of blood transfusion in total knee arthroplasty was reduced by 81% using IV TXA, by 66% using topical TXA and by 61% using oral TXA when compared to placebo.…”