November 19, 2018
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Perioperative TXA may not affect risk for cardiovascular events, death after THA

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Tranexamic acid did not demonstrate a significant effect on the risk for cardiovascular events or death after total hip arthroplasty, according to a recently published study.

“Our project established unambiguous linkage at the individual level between several national databases with validated data and complete or near-complete national coverage,” Alexander Dastrup, MD, told Healio.com/Orthopedics. “We used propensity score matching to control for measured confounders and we had complete 30-day follow-up of the included patients. Our data does not support a detrimental effect of tranexamic acid on the risk of cardiovascular events or death following THA. As blood transfusion after THA is associated with an increased risk of pneumonia and all-cause mortality, reduced blood loss and reduced risk of blood transfusions can be expected to reduce both the risk to the patient, but also the societal cost of complications following THA.”

Researchers conducted a nationwide cohort study of cardiovascular outcomes after perioperative exposure to tranexamic acid during THA and identified 45,290 patients who had a THA between 2006 to 2013. Overall, 38,586 patients received perioperative TXA and 6,704 patients did not. Investigators calculated propensity scores based on age, sex, income, year of surgery, Elixhauser comorbidity index and a variety of comorbidities and co-prescribed medications. Venous thromboembolism was the primary outcome. Other outcomes include deep venous thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke and all-cause mortality. Investigators used Cox regression to analyze data either in a multivariable model or in propensity-score matched cohorts.

The data showed all prognostic covariates balanced well after propensity scores were matched. Investigators noted TXA did not significantly increase the risk for venous thromboembolism, deep vein thrombosis, myocardial infarction, ischemic stroke or all-cause mortality. Results from the multivariable Cox regression analyses were similar. –by Monica Jaramillo

Disclosures: The authors report no relevant financial disclosures.