One Dose Versus Two Doses of Intravenous Tranexamic Acid in Revision Total Joint Arthroplasty

Tranexamic acid (TXA) is often used to reduce the amount of blood lost during total joint arthroplasty (TJA) and decrease the incidence of postoperative transfusion. Despite its extensive use, the ideal dosing regimen is still widely debated. The primary aims of this study were to compare single-dose and two-dose regimens on postoperative hemoglobin levels, transfusion rates, and 30-day complication rates in patients who underwent revision TJA.

This retrospective study included patients who underwent revision total knee arthroplasty or revision total hip arthroplasty between April 2014 and November 2020 at a single academic institution. Patients were divided into two groups: One group received a 1 g bolus of intravenous TXA just before incision and another intravenous 1 g bolus during wound closure (n = 151), and the second group received a single, 1-g, intravenous bolus of TXA just before incision (n = 189).

No notable statistical differences were found between the two cohorts when evaluating postoperative hemoglobin levels (b = -0.18, 95% confidence interval [CI]: -0.39 to 0.03; P = 0.09), transfusion rates (odds ratio [OR] = 0.74, 95% CI: 0.39 to 1.38; P = 0.34), length of hospital stay (rate ratio = 0.95, 95% CI: 0.84 to 1.08; P = 0.43), and 30-day postoperative complication rates (OR = 1.30, 95% CI: 0.54 to 3.15; P = 0.56) even after controlling for patient characteristics and surgical factors.

In this study, no association was found between a single dose of perioperative TXA during revision TJA and increased rates of post-operative complications when compared with two-doses, suggesting comparable efficacy.