Tranexamic Acid Use in Foot and Ankle Surgery

Abstract

Background: There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery. Methods: A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months. Results: Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics ( P > .05) and traumatic and nontraumatic cases ( P > .05). Conclusions: The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised. Level of Evidence: Level IV, case series.

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

“…Limitations can be attributed to the heterogeneity of included studies, limitation of their design, and risk of unknown bias. For example, the studies by Johns et al 11 and Sadoun et al 19 are observational retrospective studies with no control groups. This can potentially bias their effect on the overall outcomes.…”

The efficacy and safety of different does of intravenous tranexamic acid on blood loss in fresh foot and ankle fractures: a prospective, randomized controlled study

“…However, the application of TXA in foot and ankle surgery is relatively rare [ 30 , 31 ]. Currently, few studies have shown that TXA has potential benefits in reducing blood loss and wound complications without increasing the risk of thromboembolic events [ 32 – 34 ], but there is still some controversy [ 35 , 36 ].…”

Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study

“…Although extensively studied in other orthopaedic procedures, there lacks a consensus regarding drain use in ankle surgery. 12 , 23 Over the span of our study, tranexamic acid (TXA) became more popular in orthopaedic surgery, reducing the theoretical need for drains because of its ability to decrease blood loss and the risk of blood transfusion. Furthermore, more and more studies in the orthopaedic literature, particularly in primary hip and knee arthroplasty, suggest that drains provide minimal added benefit.…”