Tranexamic acid in TJA reduced complications in patients with preoperative coagulopathy
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According to published results, tranexamic acid administration reduced intraoperative blood loss and decreased the risk of 90-day complications for patients with preoperative coagulopathy who underwent total hip or knee arthroplasty.
Graham S. Goh, MD, and colleagues from Rothman Orthopaedic Institute at Thomas Jefferson University retrospectively reviewed perioperative outcomes of 975 TKAs and 1,148 THAs performed in patients with preoperative coagulopathy, defined as an international normalized ratio greater than 1.2, a partial thromboplastin time of greater than 35 seconds or a platelet count less than 150,000/µL.
According to the study, researchers categorized patients into two groups: those who received a single, 15 mg/kg dose of IV tranexamic acid (TXA) 20 to 30 minutes prior to incision or inflation of tourniquet (n = 240), and those who did not receive TXA (n = 1,883). Outcome measures included operative time, blood loss and 90-day complication rate.
Goh and colleagues found patients who received TXA had less intraoperative blood loss and a 2.3-times decreased risk of 90-day complications. The TXA group had a 2.92% incidence of cardiovascular complications and a 0% incidence of wound complications. In comparison, the group of patients who did not receive TXA had a 12.1% incidence of cardiovascular complications and a 1.59% incidence of wound complications. Additionally, researchers noted the TXA group had a shorter length of stay and decreased risk of non-home discharge. No significant differences were found in 90-day readmissions or mortality between the groups.
“TXA administration decreased the incidence of perioperative complications and resource utilization in arthroplasty patients with a preoperative coagulopathy identified on preadmission testing,” Goh and colleagues wrote in the study. “These findings support the broader adoption of TXA in patients undergoing TJA, particularly when the patient has a preoperative coagulopathy.”
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