Combined intravenous, topical and oral tranexamic acid administration in total knee replacement: Evaluation of safety in patients with previous thromboembolism and effect on hemoglobin level and transfusion rate

• Published in: The knee 2017-10, Vol.24 (5), p.1206-1212
• Main Authors: Jansen, Joris A., Lameijer, Joost R.C., Snoeker, Barbara A.M.
• Format: Article
• Language: English
• Subjects: Acids; Administration, Intravenous; Administration, Oral; Administration, Topical; Aged; Antifibrinolytic agents; Antifibrinolytic Agents - administration & dosage; Arthroplasty, Replacement, Knee; Blood Transfusion - statistics & numerical data; Dosage; Dose-Response Relationship, Drug; Embolism; Female; Heart surgery; Hemoglobin; Hemoglobins - analysis; Humans; Intravenous administration; Joint replacement surgery; Joint surgery; Knee; Length of Stay - statistics & numerical data; Male; Oral administration; Patients; Prostheses; Retrospective Studies; Safety; Secondary Prevention; Studies; Thromboembolism; Thromboembolism - etiology; Thromboembolism - prevention & control; Thrombosis; Topical; Tranexamic; Tranexamic Acid - administration & dosage; Treatment Outcome; Wounds
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2017.07.004

The aims of this study were to investigate the safety of combined intravenous, oral and topical tranexamic acid (TXA) in primary total knee replacement. We assessed dose-related efficacy on hemoglobin level, transfusion, length of stay and thromboembolic complications. In addition, TXA safety in patients with previous history of thromboembolism >12months ago was monitored specifically. From January 2013 until January 2016, 922 patients were included who received TXA after primary total knee replacement. Patients without TXA administration or with thromboembolic events 10–25mg/kg and >25–50mg/kg. Between the three TXA groups no significant difference was found in thromboembolic complications (deep venous thrombosis (DVT) and pulmonary embolism (PE)), wound leakage and transfusion rate. For patients with DVT or PE in their history >12months ago specifically, no more complications were noted in higher-TXA-dosage groups compared to the low-dosage group. Length of stay was shorter in the highest-TXA-dosage group compared with lower-dosage groups (median two vs three days). With high TXA dose a smaller difference between pre- and postoperative Hb was found: the >25–50mg/kg TXA group had a 0.419mmol/l smaller decrease in postoperative hemoglobin compared to the lowest-dosage group (P12months ago. High dosage (>25–50mg/kg) TXA resulted in the smallest decrease in postoperative hemoglobin.