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VOLUME 8 , ISSUE 1 ( June, 2018 ) > List of Articles


Tranexamic Acid results in Less Blood Loss in Total Joint Arthroplasty: A Retrospective Study

Michael P Bolognesi, Samuel S Wellman, Taylor R McClellan, Rhett Hallows, Kendall E Bradley, David Attarian

Keywords : Arthroplasty, Blood loss, Tranexamic acid, Transfusion.

Citation Information : Bolognesi MP, Wellman SS, McClellan TR, Hallows R, Bradley KE, Attarian D. Tranexamic Acid results in Less Blood Loss in Total Joint Arthroplasty: A Retrospective Study. The Duke Orthop J 2018; 8 (1):43-48.

DOI: 10.5005/jp-journals-10017-1094

License: CC BY-NC 3.0

Published Online: 01-05-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Hemostasis is an essential component of surgical procedures and tranexamic acid (TXA), an antifibrinolytic, is widely used empirically in orthopedic patients. We hypothesized that TXA would significantly decrease intraoperative blood loss, the need for blood transfusion, and would decrease patient length of stay (LOS). Materials and methods: We performed a retrospective review of 496 primary total joint arthroplasties (TJAs). We recorded clinical outcomes of those given TXA since the drug was first available at our hospital in November 2012. As a control group, we reviewed all total hip arthroscopies (THAs) or total knee arthroscopies (TKAs) during the 3 months just prior to availability of TXA. Results: A total of 306 consecutive TKAs and 190 THAs were included. There were no differences in age or preoperative hemoglobin between groups. For TKAs, the difference between the preoperative hemoglobin to the first postoperative day (POD1) was 2.74 gm/dL for the “No TXA” cohort, compared with 2.07 gm/dL for the TXA cohort. Total blood loss was 571.1 vs 387.3 mL (p < 0.01). For THAs, the difference between the hemoglobin values from preoperative levels to POD1 was 3.16 gm/dL compared with 2.36 gm/dL. Total blood loss was greater for the “No TXA” group, 649.4 vs 464.1 mL (p < 0.01). Only the “No TXA” group underwent transfusion, 13.83%. Hospital LOS was longer in the “No TXA” group, 4.24 vs 3.57 days (p < 0.01). More “No TXA” were discharged to a skilled nursing or rehab compared with “home,” 35.1 vs 13.7% (p < 0.01). Conclusion: Patients with TXA had statistically significant differences in intraoperative, postoperative, and total blood loss. No patient given TXA required a transfusion. The THA patients given TXA had statistically significant shorter LOS and were more likely to be discharged to home. Therefore, TXA has the potential to improve clinical outcomes following TJA and possibly also reduce cost.

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