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Tranexamic acid may produce blood-sparing properties in revision TKA
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LAS VEGAS — Several tranexamic acid-dosing regimens yielded equivalent blood-sparing properties when used in revision total knee arthroplasty, according to results presented at The Knee Society Special Day at the American Academy of Orthopaedic Surgeons Annual Meeting.
“Surgeons should consider choosing the lowest effective dose and the least costly regimens for their patients,” Yale A. Fillingham, MD, said in his presentation here.
Fillingham and colleagues randomly assigned 186 patients undergoing revision TKA to receive 1g of IV tranexamic acid (TXA) prior to skin incision, 1g of IV TXA given both prior to skin incision and at the time of wound closure, a combination of 1g of IV TXA given prior to skin incision and 1g of intraoperative topical TXA or three doses of 1950 mg of oral TXA given 2 hours preoperatively, 6 hours postoperatively and on the morning of postoperative day 1.
“We found that all treatment groups had an equivalent amount of reduction in hemoglobin ranging between 2.6 [g/dL] and 2.9 g/dL,” Fillingham said. He added that calculated blood loss, transfusion rate and length of stay were also equivalent between the groups.
The results of this study expand upon previously published research that compared single-dose and double-dose IV TXA, according to Fillingham. The findings also contrast with other studies that found high levels of variability in the range of transfusion and a synergistic effect of use of both IV and topical TXA, he said.
“The results of our study aligned better with the clinical practice guidelines that were recently published on primary total joint arthroplasty whereby the formulation, the number of doses and the amount of tranexamic acid as given, did not alter to efficacy,” Fillingham said. “However, reduction in hemoglobin for combined IV topical tranexamic acid was similar between our study and previously published studies.” – by Casey Tingle
Reference:
Fillingham YA, et al. A multicenter randomized clinical trial of tranexamic acid in revision total knee arthroplasty: Does the dosing regimen matter? Presented at: American Academy of Orthopaedic Surgeons Annual Meeting Specialty Day; March 16, 2019; Las Vegas.
Disclosure: Fillingham reports he is a paid consultant for Johnson & Johnson and Medacta.