Is Tranexamic Acid Safe for Patients Who Have End-Stage Renal Disease Undergoing Total Joint Arthroplasty?

Tranexamic acid (TXA) is a regally excreted antifibrinolytic commonly utilized in total joint arthroplasty (TJA). This study examined whether TXA administration affected clinical outcomes and kidney function in patients who had end-stage renal disease (ESRD) undergoing TJA or hemiarthroplasty (HA).

Through a retrospective chart review, we identified 123 patients: 40 who underwent primary elective total knee arthroplasty (TKA; 65% received TXA), 34 who underwent primary elective total hip arthroplasty (THA; 52.9% TXA), and 49 who underwent nonelective THA or HA (44.9% TXA) from January 2011 to February 2024. All patients had ESRD and/or were on dialysis, with no difference in percentage on dialysis between TXA groups (TKA: 65.4 versus 64.3%; THA: 55.6 versus 50.0%; non-elective or HA: 86.4 versus 85.2%, P values ≥ 0.586). Demographic and perioperative characteristics, including preoperative hemoglobin, TXA administration, dose, and route of administration (intravenous and topical), were extracted. Pre and postoperative (≤ seven days) creatinine, perioperative transfusions, revisions, and 90-day emergency department visits, readmissions, and mortalities were recorded and compared between TXA groups.

In the total sample and all cohorts, change in pre to postoperative creatinine and incidence of postoperative acute kidney injury, per Kidney Disease Improving Global Outcomes guidelines, did not significantly differ based on receiving TXA (P values ≥ 0.159). Among patients receiving TXA, change in creatinine did not significantly differ by dose (P values ≥ 0.428) or route of administration (P values ≥ 0.256). There were no statistically significant differences in 90-day emergency department visits, readmissions, or mortalities based on receiving TXA (P values ≥ 0.055). Thromboembolic events occurred in four patients (one TXA and three no TXA, P = 0.617), and perioperative transfusions occurred in two patients (one TXA and one no TXA, P = 0.882) in the nonelective or HA cohort, with none in the elective cohorts.

The administration of TXA does not portend a significant increase in complications for patients who have ESRD undergoing TJA or HA for fracture, suggesting TXA should not be contraindicated in this population.