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Speaker notes safety and efficacy of TXA for reducing blood loss in TJR
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ORLANDO, Fla. — The use of tranexamic acid in total joint replacement successfully reduces blood loss both topically and intravenously, and more surgeons should adopt the antifibrinolytic for these procedures, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting, here.
“My current protocol is 1 gram [intravenously] IV, 50 cc at the incision and 1 gram at closure. I use no pre-donation or drains. My transfusion rate is less than 1% [and] you have less bruising and less ecchymosis,” David F. Dalury, MD, chief of orthopedics at University of Maryland St. Joseph Medical Center, said during his presentation. He noted that the recommended protocol according the pharmacist at his institution is 1 gm intravenously, but many surgeons have migrated to using 1 gm at incision and 1 gm at closure in patients.
David F. Dalury
“There seem to be various dosing schedules utilized by surgeons, but this is the one I have used successfully for several years,” he told Orthopedics Today. “We need more data on the topical vs. IV [tranexamic acid], but I think it is something that should be considered state of the art in total knee replacement [TKR] and total hip replacement [THR] in 2013,” Dalury said in his presentation. He noted that he uses the same protocol for both THR and TKR.
Although attempts to minimize blood loss through methods such as drains, tourniquets and blood donations have had mixed success, Dalury said the antifibrinolytics, particularly tranexamic acid (TXA), have had success in reducing blood loss.
“The drug can be pre-mixed by the pharmacy. It is stable and sterile for 24 hours, and you can have it delivered to the operating room for your use,” Dalury, who is also a clinical professor of orthopedic surgery at University of Maryland Medicine and an associate professor at Johns Hopkins University, said.
He also said that TXA is cost-effective, noting that it costs $50 to make in his hospital. He also cited a recently published study by Irisson and colleagues that showed total hospital costs were less for patients who received TXA compared to patients who did not receive the antifibrinolytic. – by Jeff Craven
References:
Georgiadis AG. J Arthroplasty. 2013;doi: 10.1016/j.arth.2013.03.038.
Irisson E. Orthop Traumatol Surg Res. 2012;doi:10.1016/j.otsr.2012.05.002.
Watts CD. J Bone Joint Surg Br. 2012;doi: 10.1302/0301-620X.94B11.30618.
Yang Z. J Bone Joint Surg Am. 2012;doi: 10.2106/JBJS.K.00873.
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Disclosure: Dalury receives royalties from and is a paid consultant for DePuy.