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Tranexamic acid use linked with reduced blood transfusion rate for total joint reconstruction
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LAHAINA, Hawaii — Use of tranexamic acid in total joint reconstruction is an efficient and cost-effective means to reduce blood transfusion rates, according to a presenter at Orthopedics Today Hawaii 2017.
“The best route for our high-risk patients — whether to use [tranexamic acid] intravenously, whether you use it locally or, in fact, whether you use it orally — seems to have the same relative positive effects for patients,” Steven J. MacDonald, MD, FRCS, of the University of Western Ontario, London, Canada, said in his presentation.
MacDonald noted use of tranexamic acid (TXA) during primary total joint reconstruction does not increase the risk of thrombosis and it can be used in every patient, including high-risk patients.
In a study to determine the most cost-effective dosing regimen for TXA, MacDonald and his colleagues studied the impact of a 20-mg/kg dose given prior to surgery for patients undergoing hip replacement and the same dosage given during cementation for patients undergoing knee replacement. He noted use of TXA reduced the blood transfusion rate from 13.5% to 2%. Compared with the cost of packed red blood cells at $400, MacDonald noted the average dose of intravenous TXA is about $20 and oral TXA is about $2.
Use of TXA during revision showed the same efficacy as use in primary total joint reconstruction.
“If you look at [tranexamic acid] for stage 1, a 40% reduction; stage 2 also 40%; and a combined 70% reduction in [the] risk of transfusion,” MacDonald said. “Cost-effectiveness, in our institution alone in our revision practice, [is] about $23,000,” he said noting an average of 102 revision TKAs performed per year. – by Casey Tingle
Reference:
MacDonald SJ. Tranexamic acid in TJA. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.
Disclosure: MacDonald reports that he received institutional/educational support from Smith & Nephew, DePuy and Stryker; is a consultant for and received royalties from DePuy; and is a stockholder with Hip Innovations Technologies and JointVue.