Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement.

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Pharmacology

Background:

• Tranexamic acid (TXA) is an antifibrinolytic agent used to manage hyperfibrinolytic states and prevent hemorrhage.
• It is commonly employed in severe polytrauma and elective orthopedic procedures.
• This review focuses on TXA's use before major hip and knee endoprosthetic surgery.

Purpose of the Study:

• To evaluate the efficacy of prophylactic tranexamic acid administration.
• To assess the risks associated with its use in major endoprosthetic hip and knee surgery.

Main Methods:

• A selective literature search was conducted in PubMed and Cochrane Library databases.
• Pertinent articles were retrieved and analyzed for relevant data.

Main Results:

• Prophylactic TXA significantly reduces intra- and postoperative bleeding in hip and knee endoprosthetic surgery.
• It also decreases the likelihood of blood transfusion, with NNTs ranging from 3.7-8.2.
• Thromboembolic event rates did not differ significantly from placebo; epileptic seizures are unlikely at standard doses.

Conclusions:

• Intravenous tranexamic acid effectively reduces bleeding and transfusion requirements in endoprosthetic hip and knee procedures.
• Complications are generally rare, but contraindications include recent urogenital bleeding, pulmonary embolism, myocardial infarction, recent PCI, or known epilepsy.