Is Tranexamic Acid Safe for High-Risk Patients Undergoing Total Joint Arthroplasty?

Use of tranexamic acid (TXA) to reduce bleeding during total joint arthroplasty (TJA) did not appear to increase the risk of postoperative pulmonary embolism, stroke, or myocardial infarction in patients with a history of venous thromboembolism or deep vein thrombosis, according to a database analysis.

Instead, “patients who received TXA had a decreased risk of transfusion and readmission,” suggested the study’s lead author, Mark Richardson, and colleagues from the Keck School of Medicine of the University of Southern California in Los Angeles. Findings were published in The Journal of Bone and Joint Surgery.

Tranexamic Acid Appears Safe in High-Risk Patients

The analysis included 70,759 high-risk patients in the Premier Healthcare Database who underwent elective TJA from 2015 to 2021, of which 46,074 (65.1%) received TXA and 24,685 (34.9%) did not. Investigators compared patient characteristics, hospital factors, patient comorbidities, antithrombotic medications, perioperative blood transfusions, and 90-day complication rates between patients who did or did not receive TXA during TJA.

After adjusting for confounders, the study found patients in the TXA and non-TXA groups had comparable risks of pulmonary embolism (adjusted odds ratio [OR], 0.90; 95% CI, 0.79-1.02; P=.097), stroke (adjusted OR, 0.97; 95% CI, 0.69-1.37; P=.867), and myocardial infarction (adjusted OR, 0.93; 95% CI, 0.69-1.24; P=.614).

Compared with patients who did not receive TXA, patients who did had lower risks of transfusion (adjusted OR, 0.42; 95% CI, 0.38-0.46; P<.001) and readmission within 90 days (adjusted OR, 0.87; 95% CI, 0.80-0.94; P<.001).

Ultimately, “this evidence suggests that TXA may be safely utilized among select high-risk patients,” the study’s authors concluded.

Reference

Richardson M, Liu K, Mayfield C, et al. Tranexamic acid is safe in patients with a history of venous thromboembolism undergoing total joint arthroplasty. J Bone Joint Surg Am. 2023;10.2106/JBJS.23.00254. doi:10.2106/JBJS.23.00254

Related: How Often is Asymptomatic DVT Found in Elective General Surgery for Benign Disease?