ORLANDO, Fla. — An effective method to minimize perioperative blood loss without increasing the risk of thromboembolic events for patients who undergo total knee replacement is the use of tranexamic acid, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.
“Tranexamic acid (TXA) is really a game changer,” said Edwin P. Su, MD, here.
He said it has been estimated previously that 50% of patients are going to require allogeneic blood donation, which has risks of infectious disease and increased hospital stays. Additionally, the benefit of controlling perioperative blood loss can result in greater function and range of motion for patients.
Edwin P. Su
In the perioperative management of blood loss, he said that orthopedic surgeons can improve patient outcomes with the administration of TXA, an antifibrinolytic that prevents clot dissolution. It can be given topically or intravenously, however, the recommendations are for TXA not to be used intravenously for patients with a history of venous thromboembolism, cardiac stents or renal insufficiency.
“There are multiple studies out there that show it is safe, effective and inexpensive. If you have to use it topically, if you have a contraindication to the intravenous [administration], it is very easy. We use 3 g of TXA, which makes a volume of 30 mL. [We] just pour it into the wound before the tourniquet is let down. You let it sit for 3 [minutes] to 5 minutes. Once you let the tourniquet down, it is very effective at reducing blood loss and has decreased the transfusion risk,” he said.
For intravenous administration, Su said he uses two doses — 10 mg to 15 mg per kg before incision and then a second dose about 3 hours later. Hospital for Special Surgery, in conjunction with the Mayo Clinic, is currently conducting a study to compare topical and intravenous administration of TXA.
“The results in the literature do show benefits to both methods,” he said. “Multiple studies have shown that TXA is effective to reducing blood loss and transfusion rather without increases in the thromboembolic rate.” – by Kristine Houck, MA, ELS
Su EP. Paper #83. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 10-13, 2014; Orlando, Fla.
Disclosure: Su has no relevant financial disclosures.