Tranexamic acid can aid total hip and knee arthroplasty

More than 1 million Americans have hip or knee replacement surgery every year, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This type of surgery can be common in seniors, as it will allow them to move around easier and reduce pain. As with any other medical procedure, there are risks involved. Common risks associated with total hip or knee replacement surgery are blood loss and clots as well as renal failure. Therefore, patients frequently require blood transfusions.

A recent study conducted by the Mount Sinai Hospital System's Department of Health Evidence and Policy and published by the British Medical Journal found that the use of tranexamic acid decreases the need for blood transfusions without increasing the risk for thromboembolic events or renal failure in patients undergoing either form of joint replacement surgery. According to the Mayo Clinic, tranexamic acid is an antifibrinolytic agent that blocks the breakdown of blood clots in order to prevent bleeding.

The process
Researchers began the study by collecting information from the Premier Perspective database, which contains information of surgical hospital discharges from January 2006 to October 2012. Any cases using the ICD-9 codes 81.51 and 81.54, which represent total hip and knee arthroplasty, were analyzed. This totaled 872,416 different patient outcomes from 510 hospitals. The researchers noted that the information gathered lacked hemoglobin levels and other transfusion triggers.

Conclusions
The result of the study was that tranexamic acid can be associated with a reduction in the need for allogeneic or autologous blood transfusions by 69 percent. Additionally, the researchers found that tranexamic acid is not related to an increased risk for perioperative complications such as thromboembolic events and acute renal failure. Without taking variables into consideration, it was discovered that the use of the antifibrinolytic agent also lowered rates of necessary advanced care, reduced costs of the hospital stay and resulted in less time spent in the hospital.

Clinical significance
Robert Molloy, M.D., director of the Center for Adult Reconstruction in Orthopaedic Surgery at the Cleveland Clinic in Ohio, told Medscape that the authors should be commended for using the large population of patients. It is generally considered that the bigger the test group, the more accurate the results will be.

"While the reduction in blood utilization is not surprising, this article further substantiates the efficacy and safety profile of [tranexamic acid] in the total joint population," Molloy informed Medscape. "I believe that the use of [tranexamic acid] should be the standard of care for patients undergoing total joint arthroplasty, possibly utilizing topical [tranexamic acid] in higher-risk patients, and that further study is warranted to validate its safety in the high risk patient population."

The study noted that, in the past, tranexamic acid was used modestly, as complications were always a concern of orthopedic surgeons. The researchers would like to further examine outcome data in subpopulations of patients to determine the specific effectiveness and safety, as well as discover the optimal dose of tranexamic acid for total hip and knee replacement surgery.