Thomas P. Schmalzried
ORLANDO — Tranexamic acid is an efficacious and economical strategy to reduce bleeding among patients who undergo total joint arthroplasty, a presenter at the Current Concepts in Joint Replacement Winter Meeting said, here.
“It is inexpensive,” said Thomas P. Schmalzried, MD, who polled the audience of arthroplasty surgeons at the meeting to learn most of them already use tranexamic acid (TXA), which is an antifibrolytic.
He said dosing ranges from 10 mg/kg to 15 mg/kg IV, 1 g to 2 g in 30 mL to 100 mL of normal saline topical or 1 g to 2 g oral. The optimal TXA dosing regimen is typically a point of discussion among orthopedic surgeons and in studies of TXA use in orthopedic surgery, and care with its use must be taken in patients with chronic renal failure, Schmalzried noted.
“Any administration of TXA is associated with reduced bleeding compared to no TXA. The greatest efficacy is preincision,” he said.
Schmalzried, who is an Orthopedics Today Editorial Board Member, said one area of TXA use for which more data are needed concerns multiple doses and the timing and form of administration.
“Systemic plus topical may be more effective than either administration alone. Oral administration is the least expensive,” he said.
“Further safety evaluations should be directed toward patients at higher risk for complications after receiving TXA, such as those with previous coronary artery stents. Topical administration is recommended for patients with a history of venous thromboembolic disease,” Schmalzried said.
The need for allogeneic transfusions during revision TJA surgery can be mitigated when TXA is used in addition to a cell saver, he said. – by Susan M. Rapp
Schmalzried TP. Paper 39. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 11-14, 2019; Orlando.
Disclosure: Schmalzried reports no relevant financial disclosures.