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TXA decreases rate of blood transfusion in THA
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Application of tranexamic acid can greatly decrease the rate of blood transfusion in total hip arthroplasty, according to study results.
Using transfusion data and the patient cohort from a case-control study, researchers performed a cost analysis for total hip arthroplasty (THA) comparing tranexamic acid (TXA) usage, categorizing patients into no-TXA, intravenous TXA (IV-TXA) and topical TXA treatment groups during record reviews.
Compared with the ratio of money spent on blood transfusion in patients who did not receive TXA, results showed a 54% reduction in cost associated with blood transfusion when topical TXA was utilized and a 57% savings when IV-TXA was utilized. The researchers calculated a facility cost of $300,380 among 208 blood transfusions in the no-TXA group, a facility cost of $58,977.95 among 21 transfusions in the IV-TXA group and a facility cost of $9,269.84 among nine transfusions in the topical TXA group.
According to study results, there was a 68.89% reduction in man-hours associated with blood transfusion when topical TXA was utilized and an 84.44% reduction in man-hours when IV-TXA was utilized. When comparing the cost of man-hours for blood transfusion, the researchers found the no-TXA group had a cost of 472.2 man-hours compared with 32.2 man-hours in the IV-TXA group and 9.9 man-hours in the topical-TXA group.
Although the results showed little difference in facility costs between IV-TXA and topical-TXA in THA, blood transfusions took twice as many man-hours in the topical-TXA group vs. the IV-TXA group. – by Casey Tingle
Disclosure: Harris reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to TopMohamed Sukeik, MD, MRCSEd, PGA
This a retrospective case controlled study reviewing the cost-savings achieved over a four-year period related to the use of tranexamic acid (TXA) in primary THAs. Patients were divided into three treatment groups: 1) no-TXA (1047 patients), 2) IV-TXA (478 patients), and 3) Topical-TXA (70 patients). The use of TXA reduced transfusion rates and overall costs related to transfusion with more profound results in the IV-TXA group (57% costs and 84% man-hours reduction) compared to the Topical-TXA group (54% costs and 69% man-hours reduction).
Strengths of this study include the following:
1) The large number of patients included in the study over a 4 years period
2) Reviewing cost savings as well as mans-hour reduction related to the use of TXA which has not been previously assessed simultaneously in one study
3) The results which supported the current literature with significant savings achieved using TXA in THA surgery
4) Comparing the results with evidence from the current literature
On the other hand, weaknesses of this study include the following:
1) The retrospective nature of the analysis which weakens end point estimates
2) The comparison of IV and Topical TXA in dissimilar circumstances, i.e. patients who had contraindications to the use of IV TXA received topical TXA which may have influenced the results. The ideal comparison should include patients who qualify to have either treatment as this would reflect a more homogenous population to test the hypothesis.
3) Authors state that ‘Autologous blood transfusion is the event for determining possible cost savings of TXA usage.’ However, their facility cost estimation was based on allogeneic blood transfusion costs. It may be worth further clarifying when they used autologous vs allogeneic blood transfusion in their cohort.
4) There was no analysis of complications which may influence cost significantly as pointed out by the authors themselves. Therefore, a prospective study of cost analysis would be more ideal to investigate this and give more reliable results.
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