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J Arthroplasty. 2017 Oct;32(10):2990-2994. doi: 10.1016/j.arth.2017.03.063. Epub 2017 Apr 6.

Oral Tranexamic Acid Reduces Transfusions in Total Knee Arthroplasty.

Author information

1
Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts.
2
Division of Nursing, New England Baptist Hospital, Boston, Massachusetts.
3
Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
4
Section of Hematology, Department of Medicine, New England Baptist Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Tranexamic acid (TXA) reduces intraoperative blood loss and transfusions in patients undergoing total knee arthroplasty. Although numerous studies demonstrate the efficacy of intravenous and topical TXA in these patients, few demonstrate the effectiveness and appropriate dosing recommendations of oral formulations.

METHODS:

A retrospective cohort study was performed to evaluate differences in transfusion requirements in patients undergoing primary unilateral total knee arthroplasty with either no TXA (n = 866), a single-dose of oral TXA (n = 157), or both preoperative and postoperative oral TXA (n = 1049). Secondary outcomes included postoperative hemoglobin drop, total units transfused, length of stay, drain output, and cell salvage volume.

RESULTS:

Transfusion rates decreased from 15.4% in the no-oral tranexamic acid (OTA) group to 9.6% in the single-dose OTA group (P < .001) and 7% in the 2-dose group (P < .001), with no difference in transfusion rates between the single- and 2-dose groups (P = .390). In addition, postoperative hemoglobin drop was reduced from 4.2 g/dL in the no-OTA group to 3.5 g/dL in the single-dose group (P < .01) and to 3.4 g/dL in the 2-dose group (P < .01), without a difference between the single- and 2-dose groups (P = .233).

CONCLUSION:

OTA reduces transfusions, with greater ease of administration and improved cost-effectiveness relative to other forms of delivery.

KEYWORDS:

anemia; blood transfusion; complications; total knee arthroplasty; tranexamic acid

PMID:
28757131
DOI:
10.1016/j.arth.2017.03.063
[Indexed for MEDLINE]

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