IV TXA significantly reduced transfusion rate in revision TKA cases
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Use of IV tranexamic acid in revision total knee arthroplasty significantly reduced transfusion rates by almost twofold, according to study results.
“The use of intravenous tranexamic acid (TXA) has truly revolutionized primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA),” Matthew P. Abdel, MD, told Healio Orthopedics. “This is in large part due to Mark W. Pagnano, MD, chair and professor, department of orthopedic surgery, Mayo Clinic, who was the first to use IV TXA in the hip and knee arthroplasty starting in the year 2000. However, less information is available to clinicians in the revision setting. In this large retrospective study of nearly 3,000 revision TKAs completed at the Mayo Clinic, we found a twofold reduction in blood transfusions (39% to 13%; P < .001), with a low rate of venous thromboembolic events (1.2%).”
Researchers retrospectively reviewed 2,951 revision TKAs performed between 2005 and 2014. Intravenous TXA was used in 1,144 revision TKAs. Primary outcomes included transfusion rates and symptomatic venous thromboembolic events (VTE). A unique propensity model was used to compare patients given TXA and patients who were not given TXA to mitigate bias on the basis of TXA and subsequently for aseptic or septic revision etiology.
Results showed transfusion rates overall were significantly reduced when TXA was given during revision TKAs compared to when it was not given (13% vs. 39%). This included revisions for aseptic etiology (6% with TXA vs. 28% without TXA) and septic etiology (31% with TXA vs. 54% without TXA). In patients given TXA, the risk of postoperative symptomatic VTE was not significantly different at 11 events vs. 24 events in patients not given TXA. (1% vs. 1.3%). – by Monica Jaramillo
Disclosure: Abdel reports he is a paid consultant for and receives royalties from Stryker.
Perspective
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Yale A. Fillingham, MD
Dr. Hines and colleagues performed a retrospective review of 2,951 revision TKAs from an institutional database demonstrating the efficacy and safety of TXA. Although randomized clinical trials have shown the efficacy of TXA in revision TKA, prospective studies are difficult to obtain adequate enrollment to detect differences in rare events like VTE. Therefore, database studies are better suited to more readily answer safety-related inquiries.
While the authors provide additional information favoring the safe and effective use of intravenous TXA, two methodologic limitations must be highlighted. First, the authors only subcategorize type of revision as aseptic or septic, but don’t account for other differences (ie, aseptic femoral revision and aseptic two-component revision were viewed as equivalent). However, if the vast majority of revisions were two component, their categorizations likely had little effect on the results. Second, the authors demonstrate the baseline characteristics of the TXA group had significantly lower operative time, anesthesia time and fewer patients with an American Society of Anesthesiologist physical status score of 3 or 4. The baseline characteristic differences could be affecting the observed rates of transfusion or VTE to favor the TXA group. However, TXA has overwhelming evidence to favor its efficacy, so it potentially allows for less intraoperative bleeding into the field, thereby assisting to reduce the operative time.
Rothman Institute
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