Thomas P. Schmalzried
ORLANDO — Since its introduction in orthopedics, tranexamic acid has been found to be a safe, effective and inexpensive way to decrease blood loss during total joint arthroplasty, according to a presentation at the Current Concepts of Joint Replacement Winter Meeting.
An antifibrinolytic, tranexamic acid is on the “list of essential medicines, the most effective and safe medicines in the world” from WHO and has been found to be inexpensive and broadly efficacious for stopping bleeding, said Thomas P. Schmalzried, MD.
“Initial utilization in total hip and total knee was not until the late 1990s and, even after that, there was slow acceptance in the arthroplasty community, mostly because of concerns for thromboembolic disease,” Schmalzried said in his presentation here.
He noted dosing ranges from 1 gram to 3 grams total dose, 1 gram to 2 grams intravenously, 30 mL to 100 mL normal saline for topical or 1 gram to 2 grams oral, but it is recommended to reduce systemic doses in patients with renal failure. Schmalzried said systemic plus topical administration may be more effective compared with either administration alone. He added that oral administration is the least expensive option.
“The greatest efficacy is pre-incision,” Schmalzried said. “There are conflicting opinions regarding multiple doses, ie pre-incision, plus then again in about 3 hours.”
However, despite debates on dosage and optimal routes of administration, according to Schmalzried, “any administration of [tranexamic acid] TXA is associated with reduced bleeding compared to no TXA.”
Although previously published studies have shown that tranexamic acid is safe for most patients, Schmalzried noted patients at greater risk of complications after receiving tranexamic acid, such as patients with previous coronary artery stents, should receive further safety evaluation.
“On that note, topical administration is recommended for patients with a history of venous thromboembolic disease,” Schmalzried said. – by Casey Tingle
Schmalzried TP. Paper 37. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2018; Orlando.
Disclosure: Schmalzried reports he receives royalties from DePuy Synthes and Johnson & Johnson; and has ownership interest in Myoscience.