Perspective from Michael B. Cross, MD
September 10, 2018
2 min read

Tranexamic acid may reduce transfusion risk after TJA

Perspective from Michael B. Cross, MD
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Tranexamic acid has been shown to be cost effective and beneficial in reducing the risk of transfusion after total joint arthroplasty, according to a presenter.

“It is interesting when you look back at your historical transfusion risk. We were around 13% prior to tranexamic acid and the year following that we were down to 2% to 3% and we did not do anything other than use tranexamic,” Steven J. MacDonald, MD, said in his presentation.

Systematic reviews, meta-analyses and randomized clinical trials have shown that tranexamic acid (TXA) is effective in reducing the risk of blood loss during TJA, MacDonald said. TXA can be used intravenously in patients at high risk for transfusion if they have not received a stent in the past 3 months, he said.

“All of the trials show that [tranexamic acid] favors decreased transfusion and they also show there is not an increased risk of thrombosis,” MacDonald said.

TXA can be cost-effective, he said.

MacDonald reported a transfusion in Canadian dollars (CAD) cost $400 compared with $20 CAD for an average dose of TXA. Although TXA can be given intravenously, by injection or orally, oral application may be the most cost-efficient, he noted.

An IV dose of TXA is based on the patient’s weight, according to MacDonald. It is used immediately prior to incision in total hip arthroplasty and a few minutes before releasing the tourniquet in total knee arthroplasty.

Among patients undergoing revision TKA, there was a reduction in transfusion by 47%, 40% and 71% in infected cases undergoing stage I revision, stage II revision and a standard revision, respectively, he said.

“We use it in all our revisions at the same cost effectiveness,” MacDonald said. “At our institution, we have saved around $25,000 (CAD) a year with this simple methodology.” – by Casey Tingle


MacDonald SJ. Minimizing blood loss in total joint arthroplasty. Presented at: Orthopedics Today Hawaii 2018; Jan. 7-11, 2018; Koloa, Hawaii.

For more information:

Steven J. MacDonald, MD, FRCS, can be reached at 1151 Richmond St., London, Ontario, Canada, N6A 3K7; email:

Disclosure: MacDonald reports he receives royalties and consulting fees from DePuy Synthes; and has ownership interest in Hip Innovations Technology and JointVue LLC.