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Early anticoagulation balances antifibrinolysis after knee arthroplasty with tranexamic acid
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Postoperative venous thromboembolism rates do not differ in patients who receive tranexamic acid when undergoing primary unilateral total knee arthroplasty, Chinese researchers confirmed.
However, the findings published in Thrombosis Research suggest treatment with anticoagulants should be initiated early on after the administration of the synthesized antifibrinolytic agent to maintain balance between the two.
“Earlier anticoagulation is vital for thromboprophylaxis,” the researchers wrote. “However, earlier anticoagulation may increase the risk of postoperative bleeding because of the hyperfibrinolysis resulted from trauma and tourniquet.”
Jinwei Xie
Jinwei Xie, MD, and colleagues at West China Hospital of Sichuan University in Chengdu, Sichuan province, China, prospectively collected data from consecutive patients (n = 2,532) at the institution through the National Health Database for a cohort study; 2,222 patients received tranexamic acid, and 310 patients did not.
The investigators primarily sought the rates of VTE and mortality during the 30 days after surgery. The researchers also performed subgroup analysis based on how tranexamic acid was administered.
Vascular occlusive events occurred more in patients who received tranexamic acid than those who did not (17.55% vs. 9.35%; P < .001); the events were observed only in calf veins, and the main difference was seen in calf muscular veins (13.68% vs. 6.77%; P = .001).
No between-group differences were seen for deep vein thrombosis, whether symptomatic or asymptomatic; the subgroup analysis also revealed no difference. Further, no symptomatic pulmonary embolisms or patient deaths occurred within 30 days.
“In our institution, we start anticoagulation sequential antifibrinolysis at 6 [hours] postoperatively to balance them when [tranexamic acid] was used in [total knee arthroplasty],” the researchers wrote. “This study and our previous research also confirmed the efficacy and safety of our novel theory.” – by Allegra Tiver
Disclosure: Xie reports no relevant financial disclosures.
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