Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1473-1476
The Journal of Arthroplasty

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2013.06.011Get rights and content

Abstract

The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3 g TXA per 100 mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.

Section snippets

Methods

Following approval of the University of Pittsburgh Medical Center's institutional review board, all patients undergoing primary THA and TKA over an eighteen month period by a single surgeon at a single institution were enrolled. This study evaluated a process change within our blood management program. The TXA group consists of all patients for one year after introducing a topical TXA protocol, and the control group consists of all the patients in the six months prior to implementing a topical

Results

From September 2010 until March 2011 all patients undergoing total joint arthroplasty did not receive any TXA. During this time 40 patients underwent primary unilateral THA, and 29 patients underwent primary unilateral TKA. All of these patients were included in the study. From March 2011 onwards, TXA was used in all cases. Between March 2011 and March 2012, 93 patients underwent primary unilateral THA, and 130 patients underwent primary unilateral TKA. All but two of these patients were

Discussion

Topical administration of TXA at the end of TKA and THA significantly reduced postoperative bleeding and risk for transfusion. The blood loss was 20 and 25% higher, respectively, in TKA and THA when TXA was not used. The drop in Hgb was 20 and 27% higher, respectively, in TKA and THA when TXA was not used. This translated into a much lower risk of requiring a blood transfusion in both the TKA and THA patients in which TXA was used. None of the TKA patients with TXA required a transfusion

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  • Cited by (0)

    Financial support: This research was supported by a grant from the National Institutes of Health (T32GM075770).

    Conflicts of Interest: none pertaining to the material in this manuscript.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.011.

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