Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety

• Published in: BMJ (Online) 2014-08, Vol.349 (aug12 8), p.g4829-g4829
• Main Authors: Poeran, Jashvant, Rasul, Rehana, Suzuki, Suzuko, Danninger, Thomas, Mazumdar, Madhu, Opperer, Mathias, Boettner, Friedrich, Memtsoudis, Stavros G
• Format: Article
• Language: English
• Subjects: Acids; Adult; Aged; Anticoagulants; Antifibrinolytic agents; Antifibrinolytic Agents - therapeutic use; Arthroplasty (hip); Arthroplasty (knee); Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Knee - methods; Blood Loss, Surgical - prevention & control; Blood Transfusion; Blood transfusions; Bone surgery; Comorbidity; Confidence intervals; Databases, Factual; Embolism; Female; Hip; Hospital Mortality; Hospitals; Humans; Joint replacement surgery; Kidney diseases; Kidneys; Male; Medicaid; Medicare; Middle Aged; Myocardial infarction; Myocardial Infarction - chemically induced; Orthopedics; Patients; Pulmonary Embolism - chemically induced; Regression analysis; Renal failure; Safety; Statistics as Topic; Stroke - chemically induced; Thromboembolism; Thrombosis; Tranexamic Acid - therapeutic use; Treatment Outcome; United States; Variables; Venous Thrombosis - chemically induced
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.g4829

Objective To determine the effectiveness and safety of perioperative tranexamic acid use in patients undergoing total hip or knee arthroplasty in the United States.Design Retrospective cohort study; multilevel multivariable logistic regression models measured the association between tranexamic acid use in the perioperative period and outcomes.Setting 510 US hospitals from the claims based Premier Perspective database for 2006-12.Participants 872 416 patients who had total hip or knee arthroplasty.Intervention Perioperative intravenous tranexamic acid use by dose categories (none, ≤1000 mg, 2000 mg, and ≥3000 mg).Main outcome measures Allogeneic or autologous transfusion, thromboembolic complications (pulmonary embolism, deep venous thrombosis), acute renal failure, and combined complications (thromboembolic complications, acute renal failure, cerebrovascular events, myocardial infarction, in-hospital mortality).Results While comparable regarding average age and comorbidity index, patients receiving tranexamic acid (versus those who did not) showed lower rates of allogeneic or autologous transfusion (7.7% v 20.1%), thromboembolic complications (0.6% v 0.8%), acute renal failure (1.2% v 1.6%), and combined complications (1.9% v 2.6%); all P