Acute Limb Ischemia after Total Hip Arthroplasty in a High-Risk Patient – Is Tranexamic Acid to Blame?

Abstract

Tranexamic acid (TXA) is widely used to limit the blood loss during total joint arthroplasty without an increased risk of thromboembolic events. We present a case of acute limb ischaemia due to thrombotic occlusion of the superficial femoral artery on the non-operated limb following a total hip arthroplasty in a 64-year-old male patient. Untreated peripheral artery disease, intravenous TXA administration, surgery, obesity and hypertension were identified as predisposing factors of the occlusion. Good reperfusion of the limb was obtained after mechanical thrombectomy. Other cases report that antifibrinolytic agents such as TXA could be associated with arterial thrombosis. The necessity to detect the risk factors of thrombotic events in each patient scheduled for total joint arthroplasty is emphasized. Therefore, topical TXA administration could be a reasonable alternative in a high-risk patient.