The Hip: Preservation, Replacement and Revision

Tranexamic Acid

Discussion:

  TXA use & postop outcomes in patients w/ THR or TKA in US: retrospective analysis of effectiveness & safety.
            872,416 patients who had total hip or knee arthroplasty
            Tranexamic acid
was effective in reducing the need for blood transfusions while not increasing the risk of complications, including
            thromboembolic events and renal failure.


  The Michigan Experience with Safety and Effectiveness of Tranexamic Acid Use in Hip and Knee Arthroplasty.  
            23,236 primary total knee arthroplasty cases and 11,489 primary total hip arthroplasty cases
             We found the TXA group received significantly fewer blood transfusions. In addition, our large, statewide experience supports
             other smaller studies that have not shown an increase in blood clots or cardiovascular events. In fact, we found an association
             with fewer blood clots in knee replacement patients and fewer readmissions in hip replacement patients.”

                Making Tranexamic Acid the Standard of Care in Hip and Knee Arthroplasty: Commentary on an article by Brian Hallstrom, MD, et al.: "The Michigan Experience with Safety and Effectiveness of Tranexamic Acid Use in Hip and Knee Arthroplasty".
                        T
he large database study by Hallstrom et al., which involved almost 35,000 patients, may finally put these concerns to rest
                        and allow for antifibrinolytics to become the standard of care in TJA. Once again, no increase in the risk of VTE or in
                        cardiovascular events was demonstrated
, while the benefits remained substantial.


     
Tranexamic acid use during total hip arthroplasty: A single center retrospective analysis.
               Retrospective chart review of 564 primary and revision THAs performed at a single academic center
               Significantly higher Hb and Hct values were found across all time points among patients undergoing primary posterior
               or revision THA who had received TXA.

               Significantly fewer MIs, strokes, ischemic events, and CHF events occurred within the TXA group vs no-TXA group.

                    In the TXA group, 2 (0.51%) primary posterior THA patients experienced MI 1 primary anterior, 3 primary posterior, and 3
                      revision patients experienced MI in the no-TXA group (4.12%) (
P = .0041). More strokes occurred within the no-TXA group
                      than the TXA group (9 (5.29%) vs 3 (0.76%), respectively;
P = .0016).

Perioperative Tranexamic Acid Treatment and Risk of Cardiovascular Events or Death After Total Hip Arthroplasty
A Population-Based Cohort Study from National Danish Databases






Perceived Complications:


      Tranexamic Acid Does Not Raise the Risk for Thrombotic Events
             The new study should "really resolve all of those questions, and probably also provide some great reassurance for people who
              use this drug outside of cardiac surgery," Dr Myles told Medscape Medical News in an interview. "There doesn't appear to be
              any signal or risk of thrombosis at all, it clearly reduces bleeding and reduces blood transfusion, and it can therefore improve
              the quality of recovery," he added.
              The ATACAS analysis was simultaneously published online in the New England Journal of Medicine.
              Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery


 Acute Coronary Artery Thrombus After Tranexamic Acid During Total Shoulder Arthroplasty in a Patient With Coronary Stents:
     Tranexamic acid: less bleeding and less thrombosis?
      ST elevation myocardial infarction after tranexamic acid: first reported case in the United States.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, March 5, 2019 2:12 pm