Tranexamic Acid Use in the Total Hip and Total Knee Arthroplasty Population at an Academic Medical Center: a Retrospective Review of Postoperative Outcomes

Abstract

INTRODUCTION: Excessive blood loss and subsequent blood transfusions for orthopedic procedures have been associated with considerable morbidity and mortality. Tranexamic acid (TXA), a synthetic amino acid analog, acts as an antifibrinolytic agent by competitively inhibiting plasminogen activation. RESEARCH QUESTION OR HYPOTHESIS: What is the incidence of perioperative blood transfusion after hip or knee arthroplasty with the use of TXA versus standard procedure? What is the difference in perioperative thromboembolic complication rates, hospital length of stay, and 30-day readmission rates for the two groups? STUDY DESIGN: Quasi-experimental, retrospective, cohort study. METHODS: Any adult patient who underwent a total hip or knee arthroplasty between October 1, 2012 and September 30, 2015 at our institution was eligible for inclusion. The following information was collected: baseline characteristics, surgery details including the need for blood transfusion, occurrence of perioperative thromboembolism, length of stay, and 30-day readmission rates. Categorical data was analyzed using Chi-square or Fisher's exact test and continuous data was analyzed using t-test or Mann-Whitney U test. To show statistical significance, 150 patients were needed per treatment arm. RESULTS: Two hundred ninety-eight patients were eligible for inclusion, 148 in the TXA group, and 150 in the standard procedure group. In the TXA group, 30 patients (20%) required a blood transfusion versus 48 patients (32%) in the standard procedure group (p=0.021), without any increase in thromboembolic complications [(2% vs. 3%, respectively, (p=1.0)]. The median length of stay was 3 days (Interquartile Range (IQR) 3-5 days) for the TXA group, versus 4 days (IQR 3-6 days) in the standard procedure group (p≤0.001). In the TXA group, 4.1% were readmitted within 30 days, versus 8.7% in the standard procedure group (p=0.103). CONCLUSION: TXA significantly reduced the need for blood transfusion along with the median hospital length of stay without any increase in thromboembolic complication rates or difference in 30-day readmission rates versus standard procedure.