An Evaluation of the Use of Topical Tranexamic Acid in Total Knee Arthroplasty

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Abstract

The purpose of this study was to evaluate the effectiveness of topical tranexamic acid in primary TKA from a clinical and economic standpoint. We retrospectively reviewed 683 primary total knee arthroplasties performed at a single institution over a 2-year period. We compared 373 cases performed in 2010 without tranexamic acid to 310 cases performed in 2011 with tranexamic acid. Demographic data, hemoglobin levels, transfusion rates, hospital length of stay, cost, and perioperative complications during the first 3 months were collected. Statistical analysis was performed using two sample t-tests and Fisher’s exact tests. There was no difference in age, sex, height, or pre-operative hemoglobin between the two groups. The tranexamic acid group had significantly higher post-operative hemoglobin (P < 0.0001), lower transfusion rate (P < 0.0001), decreased length of stay (P < 0.0001), decreased blood bank costs (P < 0.0001), increased pharmacy cost (P < 0.0001), and decreased total direct cost to the hospital (P < 0.0001). The average savings was approximately $1500 per patient. There were no differences in thromboembolic events or infection. The use topical tranexamic acid in primary TKA is safe, effective, and results in significant cost savings.

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Methods

After obtaining institutional review board approval, we retrospectively reviewed the charts of 683 primary total knee arthroplasty cases. We compared 373 cases performed in 2010 without the application of tranexamic acid to 310 cases performed in 2011 with the application of tranexamic acid. We excluded revisions, unicompartmental knee replacements, cases involving tumor, fracture, or hardware removal, and cases where enoxaparin was used for DVT prophylaxis. (Warfarin use is our routine and

Results

Of the 683 total cases 606 were unilateral and 77 were bilateral, for a total of 760 total knee arthroplasties (please see Table 1). There were no differences between the groups as far as age, gender, height or weight. In the non-tranexamic acid group, the mean age was 68.3 years, 67.8% were females, mean height was 1.67 meters and mean weight was 94.7 kg. In the tranexamic acid group the mean age was 68.1 years, 63.2% were females. The mean height was 1.68 meters and the mean weight was 92.9

Discussion

Tranexamic acid has been used in an effort to decrease the incidence of blood transfusion, due to the associated cost and morbidity. Application can be either intravenous or as a topical agent applied to the intra-articular surfaces at the time of wound closure. The purpose of this study was to evaluate the use of topical tranexamic acid from a clinical and economic standpoint.

The main weakness of this study is the retrospective nature. We may have missed potential complications if the patients

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    However, intravenous TXA has been associated with thromboembolic events in some patients (stroke, coronary artery disease, history of VTE).16–18 This has shifted the focus to topical application of TXA and the results were encouraging.16–21 Our results were comparable to a double-blind, placebo-controlled trial conducted by Wong and colleagues.22

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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.037.

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