Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty

TLDR: Routine use of IV TXA for TKA and THA as safe with low occurrence of thromboembolic events is suggested, although a large prospective trial should confirm this.

Abstract: Background The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences, and predictors of TE events after routine administration of IV TXA in THA and TKA. Methods Three thousand one hundred fifty-nine THA or TKA procedures performed from 2007-2013 at our institution were included. IV TXA, 1 g, was administered preoperatively if not contraindicated. Relevant patient characteristics and comorbidity information were extracted locally from the database. Data on TE events occurring within 90 days postoperatively came from The Danish National Patient Registry . Patient characteristics, comorbidities, and TE events were compared between TXA groups. A logistic regression model was used to evaluate predictors of TE events. Results Of 3159 procedures, 2766 (87.6%) received TXA (TXA+ group) preoperatively, whereas 393 (12.4%) did not (TXA− group). Mean age, distributions of gender, American Society of Anesthesiologists score, anesthesia method, duration of surgery, diagnosis, and survival status were all statistically significant different ( P values P values ≤.002). We found 31 (1.0%) TE events out of 3159 procedures, with no significant group difference in TE events (TXA+: 27 out of 2766 = 1.0%, TXA−: 4 out of 393 = 1.0%, P value = .55 for any event). For the TXA+ group, 0.5% suffered from deep venous thrombosis, 0.3% from acute myocardial infarction, and 0.2% from a pulmonary embolism. In the TXA+ group, higher age (odds ratio [OR] = 1.06, 95% confidence interval = 1.02-1.11, P  = .005) and present cardiovascular disease (OR = 4.78, 95% confidence interval = 1.72-13.28, P  = .003) were associated with an increased risk of TE events. Conclusion The findings suggest that routine use of IV TXA for TKA and THA as safe with low occurrence of TE events, although a large prospective trial should confirm this.