New Use for an Old Drug to Reduce Blood Loss in Joint Replacement Surgery

Blood loss and the need for a blood transfusion are concerns in joint replacement surgery, but a new use for an old drug is proving effective in reducing blood loss and transfusion rates, according to a study we conducted at Hospital for Special Surgery. The drug, tranexamic acid, or TXA, has been used for decades in heart surgery, to treat hemophilia and to stop excessive uterine bleeding.

After reviewing thousands of patient records, we found that TXA was safe and effective, reducing the need for a blood transfusion by more than 50 percent. The research was just presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

TXA is classified as an “anti-fibrinolytic,” or blood clot stabilizer, whose mechanism of action reduces bleeding. TXA should not be used in patients who have a cardiac stent or in those who have had a previous blood clot.

We reviewed the records of 4,449 patients who had hip or knee replacement over a six-month period. There were 720 patients who received tranexamic acid topically, 636 who received it intravenously, and 3,093 patients who received no TXA.

We found that 9.7% of patients who received TXA received a blood transfusion, compared to 22.1% of those patients who did not receive it. Patients who were not given TXA received an average of 0.37 units of blood compared to 0.13 units for patients who received the drug.
 
At our institution, TXA in either intravenous or topical form was effective in decreasing the amount of blood transfusions, as well as the number of units of blood transfused in primary and revision hip and knee replacement. Furthermore, when safety was evaluated, there was no statistically significant difference in blood clots in patients who received IV or topical TXA, reconfirming its safety.

More studies are needed comparing various doses and combining IV and topical TXA to determine what would provide the greatest benefit to patients.

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