Perspective

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

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.

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.

    Perspective
    David J. Mayman

    David J. Mayman

    The use of TXA has been revolutionary in hip and knee replacement surgery. Multiple studies have shown significant decreases in blood loss and transfusion rates since the use of perioperative TXA began.

    Although there is little debate about its efficacy, there has been a level of anxiety about the potential complications including deep vein thrombosis, pulmonary embolism, myocardial infarction and ischemic stroke. Many institutions have guidelines limiting the use of TXA in patients who are felt to be at higher risk for these complications.

    This is an excellent study, specifically looking at whether the use of TXA is correlated with higher risks of these complications. The study did not show any difference in rates of these complications in matched patients who received or did not receive TXA.

    This study should make us more comfortable using TXA in this patient population allowing these patients to receive the known benefits of this medication.

    • David J. Mayman, MD
    • Orthopedic surgery
      Hip and Knee Replacement
      Hospital for Special Surgery
      New York

    Disclosures: Mayman reports he has stock options in CyMedica Orthopedics Inc. and OrthAlign; is a consultant for Smith & Nephew and the inventor of InSight Medical.