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TXA more cost-effective than iron, EPO for anemic patients undergoing TJA
Transfusion rate was 6.7% for patients with anemia who underwent total joint arthroplasty.
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Treatment with tranexamic acid and packed red blood cells was significantly less expensive than treatment with IV iron supplementation or IV erythropoietin in patients with preoperative anemia who underwent total joint arthroplasty, according to a study.
“The message of the study was to re-examine the criteria for anemia and the need for treatment of anemia before a primary total joint with today’s use of tranexamic acid (TXA),” Ran Schwarzkopf, MD, MSc, assistant professor of the Division of Adult Reconstruction in the Department of Orthopedic Surgery at NYU Langone Medical Center, Hospital for Joint Division, told Orthopedics Today.
Cost benefits
Schwarzkopf and colleagues performed a cost analysis to compare material costs of TXA and packed red blood cells with the theoretical administration of IV iron supplementation and IV erythropoietin (EPO) in 243 patients who underwent total joint arthroplasty (TJA).
Patients were categorized into an anemic group or a nonanemic group based on their hemoglobin status. Preoperative anemia was defined by the WHO as less than 12 Hgb in femails and less than 13 Hgb in males. Patients with anemia were further categorized based on the type of arthroplasty procedure. Investigators used Fisher exact tests to compare transfusion rates among patients with or without anemia and patients with or without anemia who underwent total hip (THA) or total knee arthroplasty (TKA).
Overall, 45 patients (18.5%) had preoperative anemia. Results showed the overall transfusion rate for patients with anemia who underwent TJA was 6.7%. Among patients who underwent THA, 5 units of packed red blood cells were given in three patients with anemia, and 2 units were given to two patients who did not have anemia. No patients in the TKA group needed a transfusion.
“The clinical implications are that aggressive use of EPO and IV iron in such preoperative treatment may not be necessary for mild anemic patients in today’s modern total joint replacement culture with the use of tranexamic acid and our surgical technique,” Schwarzkopf said.
Researchers noted the combined cost for packed red blood cells and TXA was $5,317.08. Using the best-case scenario without the need for packed red blood cells postoperatively, investigators noted the cost for treatment with either iron supplementation or EPO ranged between two- to 17-times more than TXA treatment. According to researchers, 50 additional units of packed red blood cells would need to be transfused in order for the cost of treatment with TXA to be similar to that of either iron supplementation or EPO treatment.
Use of tranexamic acid
According to Schwarzkopf, tranexamic acid is being used widely in today’s treatment methods and that future research should focus on how much tranexamic acid a patient should be given and in what way, whether through IV, topical or a combination.
“Beyond that I think the next step would probably be to look at anemic patients: What is the new clinically significant anemia? When can we not waste time and resources to optimize anemia? What is the new number that patients will safely undergo their procedure?” he said. – by Monica Jaramillo and Casey Tingle
- Reference:
- Phan DL, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2015.10.001.
- For more information:
- Ran Schwarzkopf, MD, MSc, can be reached at New York University Hospital for Joint Diseases, New York University Langone Medical Center, 310 East 17th St., New York, NY 10003; email: schwarzk@gmail.com.
Disclosure: Schwarzkopf reports no relevant financial disclosures.