Single preoperative dose of tranexamic acid may decrease blood loss after TJA
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A preoperative 1-gram dose of tranexamic acid decreased blood loss in patients undergoing total hip and knee arthroplasties, according to results of the Gold Award-winning paper in orthopaedics at the Virtual EFORT Congress.
“The abundant literature does support the use of tranexamic acid,” Paul Magill, an orthopaedic hip and knee specialist from the Primary Joint Unit in Belfast, United Kingdom, said in his presentation.
In 2015, Magill and colleagues considered tranexamic acid (TXA) as a standard practice in their unit; however, concerns remained about its safety profile for patients with a history of thromboembolic disease, as well as the best period to administer TXA – either intraoperatively or postoperatively, he said.
As part of their randomized controlled trial, Magill and colleagues included 1,086 patients who underwent either elective THA or TKA. Group 1 received a 1-gram intravenous dose of TXA at surgery only, while group 2 received a 1-gram intravenous dose of TXA plus a 1-gram oral dose of TXA at 2 hours, 10 hours, 18 hours and 26 hours postoperatively. Additionally, Magill and colleagues found 4.7% of all patients had previous thromboembolism and 5.8% had previous cardiac stenting, according to the study.
After calculating indirect blood loss (IBL) at 48 hours, Magill and colleagues found TXA decreased IBL associated with THA by 38% and IBL associated with TKA by 33.6% in group 1. Investigators also found TXA reduced IBL associated with TKA another 11% in group 2, with no additional benefit for patients who underwent THA in same cohort.
Investigators concluded TXA was safe for patients with a history of thromboembolic or cardiovascular disease; however, further work is needed to identify the influence of BMI on TXA, Magill said.
Perspective
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Rafael J. Sierra, MD
Multiple individual studies and meta-analyses have shown a decrease in blood loss and transfusion rates with the use of TXA in patients undergoing TJA without an increase in complication rates, specifically thromboembolic phenomenon. In a well-done randomized trial, Paul Magill and colleagues confirm the effectiveness of TXA in reducing total blood loss for patients undergoing TKA and THA. They also showed that an additional 24-hour oral dose of TXA further reduced blood loss 11% for TKA, but without additional benefit for THA. There continues to be debate about the best dose of TXA to reduce transfusion rates after TJA. This paper confirms the effectiveness of TXA independent of route of administration and further supports its safety in patients with history of thromboembolic or cardiovascular disease.
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Magill P, et al. Paper 2299. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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