Tranexamic acid may reduce complications in ankle, hindfoot surgery
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CHICAGO — Tranexamic acid in total ankle arthroplasty and hindfoot fusion may reduce the number of superficial infections, provide shorter time to union and decrease rates of delayed wound healing, according to results presented here.
“The good thing about [tranexamic acid] TXA is we have a lot of data on its use in orthopedic patients. We know it’s safe, and we know it’s cheap. And we know a lot of our partners are giving it to almost anybody,” Daniel J. Scott, MD, assistant professor at Medical University of South Carolina, told Healio. “So, it’s an easy intervention to do that is well established, safe and is a standard of care in a lot of other orthopedic specialties.”
Scott, Christopher E. Gross, MD, and colleagues retrospectively compared patient demographics, medical history, complications and union status among 212 patients who underwent total ankle arthroplasty or ankle or hindfoot fusion between 2015 and 2020. Overall, 101 patients received TXA and 116 patients did not.
“At some point, I decided that it would be standard of practice, like my total joint colleagues, to start adding TXA into [my patients’] perioperative care because they’ve been having great results with perioperative blood loss,” Gross, associate professor of orthopedics at Medical University of South Carolina, told Healio. “So, what we did is we looked at a cohort of patients before and after we instituted this change.”
Results showed significantly fewer postoperative infections requiring oral antibiotics among patients who received TXA. Researchers also found patients who received TXA trended toward fewer superficial and deep infections requiring reoperation. Although patients who underwent hindfoot fusion and received TXA had a significantly shorter time to fusion, fewer reoperations, shorter follow-up and there were fewer active smokers, subgroup analysis showed significantly more patients had Charcot neuroarthropathy. Subgroup analysis also showed patients in the total ankle arthroplasty group who received TXA had fewer cases of superficial infections and delayed wound healing.
“The goal is to confirm this with a prospective study and we’re in the process of that,” Scott said. “But I think this is exciting for something that’s easy and safe and certainly something that we’re doing now based on this study and we certainly have other colleagues who have told us this has changed their practice.”
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Moore AD, et al. Paper 35. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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