Single perioperative dose of tranexamic acid in primary hip and knee arthroplasty

Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin. It has been shown to reduce blood loss in trauma and other haemorrhagic conditions and has recently been utilised in elective orthopaedic surgery. There are various methods of administering TXA described in the literature.

This retrospective cohort study reviews the effects of a single perioperative 1 g intravenous bolus on patients undergoing primary hip and knee arthroplasty and its effect on operative blood loss. After excluding patients who did not fulfil our inclusion criteria, a total of 110 patients were included in this study. Fifty underwent primary hip arthroplasty (30 treated with TXA; 60.0 %), and 60 underwent primary knee arthroplasty (29 treated with TXA; 48.3 %). The main outcome measure was red cell volume and total blood loss, and secondary measures were needed for blood transfusions, presence of thromboembolic events, and length of hospital stay.

Both cohorts who received TXA showed a reduction in immediate postoperative red cell volume loss and total blood loss (p < 0.01). There was no association with the administration of TXA and the rate of postoperative blood transfusions (hip p = 0.36, knee p = 0.13), incidence of symptomatic deep vein thrombosis (hip p = 0.36, knee p = 0.31), or postoperative hospital length of stay (hip p = 0.70, knee p = 0.68).

This study demonstrates that a single perioperative bolus of intravenous TXA may significantly reduce operative blood loss in both primary total hip and knee arthroplasty in a cost-effective manner, in combination with meticulous perioperative haemostasis.