The Role of Tranexamic Acid in Total Joint Arthroplasty

Research on tranexamic acid (TXA) suggests it is effective in reducing blood loss during total joint arthroplasty (TJA). During a poster presentation at the AAOS 2018 Annual Meeting, researchers from Rush University Medical Center detailed a network meta-analysis to explore the use of TXA in primary TJA on behalf of a consensus statement from the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia.

The researchers conducted a literature review of OVID-MEDLINE, EMBASE, Cochrane Reviews, SCOPUS, and Web of Science databases for all publications on TXA in primary TJA before October 2016, and identified 1,767 articles. Direct and indirect comparisons were performed for all treatments, and the results of the analysis were tested for consistency.

After critical appraisal using the Consolidated Standards Of Reporting Trials assessment of the available publications, the researchers only included the best available evidence. Topical, intravenous, and oral TXA formulations were all statistically superior to placebo for blood loss and risk of transfusion. TXA reduced blood loss and the risk of transfusion regardless the dose timing compared with placebo (p<0.05 for all). No difference was observed between all TXA formulations and placebo for risk of thromboembolic events (p<0.05 for all).

“We conclude [that] the routine use of TXA in the setting of a primary TJA is safe and effective for nearly all patients,” the authors noted.