Administration of Tranexamic Acid Improves Long-Term Outcomes in Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2020-06, Vol.35 (6), p.S201-S206
• Main Authors: Drain, Nicholas P., Gobao, Valerie C., Bertolini, Dominique M., Smith, Clair, Shah, Neel B., Rothenberger, Scott D., Dombrowski, Malcolm E., O’Malley, Michael J., Klatt, Brian A., Hamlin, Brian R., Urish, Kenneth L.
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; allogenic blood transfusion; Antifibrinolytic Agents - therapeutic use; Arthroplasty, Replacement, Knee - adverse effects; Blood Loss, Surgical; Blood Transfusion; Cohort Studies; Humans; periprosthetic joint infection; revision surgery; total knee arthroplasty; Tranexamic Acid
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2020.02.047

Blood transfusion in total knee arthroplasty (TKA) is associated with increased morbidity, including periprosthetic joint infection (PJI). Tranexamic acid (TXA) reduces blood transfusion rates, but there is limited evidence demonstrating improved outcomes in TKA resulting from TXA administration. The objectives of this study are determining whether TXA is associated with decreased rate of PJI, decreased rate of outcomes associated with PJI, and whether there are differences in rates of adverse events. A multicenter cohort study comprising 23,421 TKA compared 4423 patients receiving TXA to 18,998 patients not receiving TXA. Primary outcome was PJI within 2 years of TKA. Secondary outcomes included revision surgery, irrigation and debridement, transfusion, and length of stay. Adverse events included readmission, deep vein thrombosis, pulmonary emboli, myocardial infarction, or stroke. Adjusted odds ratios were determined using linear mixed models controlling for age, sex, thromboembolic prophylaxis, Charlson comorbidity index, year of TKA, and surgeon. TXA administration reduced incidence of PJI by approximately 50% (odds ratio [OR], 0.55; P = .03). Additionally, there was decreased incidence of revision surgery at 2 years (OR, 0.66; P = .02). Patients receiving TXA had reductions in transfusion rate (OR, 0.15; P < .0001) and length of stay (P < .0001). There was no difference in the rate of pulmonary emboli (OR, 1.20; P = .39), myocardial infarction (OR, 0.78; P = .55), or stroke (OR, 1.17; P = .77). Administration of TXA in TKA resulted in reduced rate of PJI and overall revision surgery. No difference in thromboembolic events were observed. The use of TXA is safe and improves outcomes in TKA. Level III, Observational Cohort Study.