SLR - October 2017 - Jay J. Patel; Joshua Rawa

Safety, Efficacy and Cost-Effectiveness of Tranexamic Acid in Orthopaedic Surgery

Reference: Zilan X. Lin, MD; Shane K. Woolf, MD. Safety, Efficacy and Cost-Effectiveness of Tranexamic Acid in Orthopaedic Surgery. Orthopedics. 2016; 39(2):119–130.

Scientific Literature Review

Reviewed By: Jay J. Patel, DPM; Joshua Rawa, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, MO

Podiatric Relevance: Intraoperative and postoperative bleeding often occur following podiatric surgical procedures. An antifibrinolytic pharmacologic agent, tranexamic acid (TXA), can be used to help reduce active bleeding in patients following surgical procedures. TXA presents an overall low risk for deep vein thrombosis (DVT) or pulmonary embolisms (PE) in healthy patients; however, the data for high-risk patients is lacking. The authors of the article hypothesize that the major factors causing cost savings associated with TXA use are shorter hospital stays, conservation of blood products and reduced laboratory costs.

Methods: Due to the antifibrinolytic properties of TXA, a primary concern of its use is that is may lead to a hypercoaguable state, resulting in DVT and PE complications. Several studies have argued that there is no significant difference in using TXA versus placebo in thrombus development. However, recent literature has evaluated only healthy patients and do not include patients with associated risk factors, such as cardiac disease, history of thromboembolic events and renal failure. Several contraindications have been noted: history of arterial and venous thrombosis, cerebral thrombosis, myocardial infarct and acute renal failure.

Results: In a meta-analysis, TXA was found to reduce the number of blood transfusions per patient by 0.78 units for major orthopaedic surgeries of 2,925 patients. It is found that the efficacy of TXA can vary by different locations. For example, there is a higher efficacy of TXA in Total Knee Arthroplasty versus Total Hip Arthroplasty. Also, patients who were given TXA prior to a total knee arthroplasty were found to have a hospital stay that was two days shorter than those who did not have TXA.

Conclusion: TXA has been shown in orthopaedic surgeries to control bleeding perioperatively and postoperatively as well as reduce postoperative swelling. However, the use of TXA in patients at high risk for thromboembolic complications has not been studied. TXA has shown in various studies to decrease hospital stay, operating room time and overall medical expenditure. TXA may prove beneficial to the podiatric surgeon in patients undergoing surgical procedures where increased intraoperative and postoperative bleeding are anticipated. 

Educational Opportunities