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Using topical tranexamic acid (TXA) in patients undergoing primary total hip and knee arthroplasty can reduce the need for blood transfusions, according to a study published in The Journal of Arthroplasty.
Topical TXA reduced the transfusion rate by 12%, thereby reducing transfusion costs.
Topical TXA also enabled about 9% more patients to be discharged to their homes rather than a skilled nursing facility, and it did not affect the rate of complications.
“Historically, with hip or knee replacement, there was a 25% to 30% chance of a blood transfusion,” said study author John Froehlich, MD, of The Miriam Hospital in Providence, Rhode Island.
“We realized that this high frequency of transfusions was associated with longer hospital stays and a higher risk of infections, which we are always working to avoid. Tranexamic acid has been around for 30 years, but because there was concern about the danger of administering it intravenously, we opted to inject it in the joints. We found it to be effective in reducing ongoing blood loss and the subsequent need for transfusion, and we have now standardized the practice.”
TXA is a synthetic derivative of the amino acid lysine that produces antifibrinolytic activity by competitively inhibiting lysine binding sites on plasminogen molecules. TXA helps the body stabilize blood clot formation, thereby reducing bleeding at surgical sites.
Most protocols of TXA in total joint arthroplasty have involved intravenous delivery. However, studies have indicated that topical injection may provide advantages, such as potentially reduced costs with a single injection, surgeon control, and localization and concentration of the drug more precisely at the surgical site.
“As the evidence for topical TXA grew, our arthroplasty surgeons started adopting topical TXA for total joint arthroplasty,” Dr Froehlich said.
He and his colleagues studied topical TXA in patients undergoing primary hip or knee arthroplasty by 5 surgeons from March 2012 to March 2013. Of the 591 consecutive patients, 311 received topical TXA, and 280 served as controls.
The researchers found that topical TXA reduced the proportion of red blood cell units transfused by 18%, from 28.6% to 10.6% (P<0.001). The drug also reduce the number of patients who required transfusions by 12%, from 17.5% to 5.5% (P<0.001).
On, the other hand, there was no significant difference between the TXA and control groups with regard to tourniquet time, operative time, time in the operating room, or the length of hospital stay.
Still, more patients in the TXA arm than in the control arm were able to go home rather than to a subacute nursing facility—71.4% and 62.1%, respectively (P<0.02).
And TXA conferred a cost benefit based solely on the rate of transfusion reduction. The researchers’ cost analysis revealed a net savings of $8372.66 per 100 patients treated, which amounted to $83.73 per patient.
“[Topical TXA] reduces transfusion rates, increases home disposition, and reduces cost in primary hip and knee arthroplasty,” said study author Lee Rubin, MD, of The Miriam Hospital.
“[W]e have now developed a simple, standardized, and cost-effective protocol for the use of topical TXA during total joint replacement that can be immediately used by any surgeon around the world to improve patient care.” 
Photo by Daniel Gay
Using topical tranexamic acid (TXA) in patients undergoing primary total hip and knee arthroplasty can reduce the need for blood transfusions, according to a study published in The Journal of Arthroplasty.
Topical TXA reduced the transfusion rate by 12%, thereby reducing transfusion costs.
Topical TXA also enabled about 9% more patients to be discharged to their homes rather than a skilled nursing facility, and it did not affect the rate of complications.
“Historically, with hip or knee replacement, there was a 25% to 30% chance of a blood transfusion,” said study author John Froehlich, MD, of The Miriam Hospital in Providence, Rhode Island.
“We realized that this high frequency of transfusions was associated with longer hospital stays and a higher risk of infections, which we are always working to avoid. Tranexamic acid has been around for 30 years, but because there was concern about the danger of administering it intravenously, we opted to inject it in the joints. We found it to be effective in reducing ongoing blood loss and the subsequent need for transfusion, and we have now standardized the practice.”
TXA is a synthetic derivative of the amino acid lysine that produces antifibrinolytic activity by competitively inhibiting lysine binding sites on plasminogen molecules. TXA helps the body stabilize blood clot formation, thereby reducing bleeding at surgical sites.
Most protocols of TXA in total joint arthroplasty have involved intravenous delivery. However, studies have indicated that topical injection may provide advantages, such as potentially reduced costs with a single injection, surgeon control, and localization and concentration of the drug more precisely at the surgical site.
“As the evidence for topical TXA grew, our arthroplasty surgeons started adopting topical TXA for total joint arthroplasty,” Dr Froehlich said.
He and his colleagues studied topical TXA in patients undergoing primary hip or knee arthroplasty by 5 surgeons from March 2012 to March 2013. Of the 591 consecutive patients, 311 received topical TXA, and 280 served as controls.
The researchers found that topical TXA reduced the proportion of red blood cell units transfused by 18%, from 28.6% to 10.6% (P<0.001). The drug also reduce the number of patients who required transfusions by 12%, from 17.5% to 5.5% (P<0.001).
On, the other hand, there was no significant difference between the TXA and control groups with regard to tourniquet time, operative time, time in the operating room, or the length of hospital stay.
Still, more patients in the TXA arm than in the control arm were able to go home rather than to a subacute nursing facility—71.4% and 62.1%, respectively (P<0.02).
And TXA conferred a cost benefit based solely on the rate of transfusion reduction. The researchers’ cost analysis revealed a net savings of $8372.66 per 100 patients treated, which amounted to $83.73 per patient.
“[Topical TXA] reduces transfusion rates, increases home disposition, and reduces cost in primary hip and knee arthroplasty,” said study author Lee Rubin, MD, of The Miriam Hospital.
“[W]e have now developed a simple, standardized, and cost-effective protocol for the use of topical TXA during total joint replacement that can be immediately used by any surgeon around the world to improve patient care.”
Photo by Daniel Gay
Using topical tranexamic acid (TXA) in patients undergoing primary total hip and knee arthroplasty can reduce the need for blood transfusions, according to a study published in The Journal of Arthroplasty.
Topical TXA reduced the transfusion rate by 12%, thereby reducing transfusion costs.
Topical TXA also enabled about 9% more patients to be discharged to their homes rather than a skilled nursing facility, and it did not affect the rate of complications.
“Historically, with hip or knee replacement, there was a 25% to 30% chance of a blood transfusion,” said study author John Froehlich, MD, of The Miriam Hospital in Providence, Rhode Island.
“We realized that this high frequency of transfusions was associated with longer hospital stays and a higher risk of infections, which we are always working to avoid. Tranexamic acid has been around for 30 years, but because there was concern about the danger of administering it intravenously, we opted to inject it in the joints. We found it to be effective in reducing ongoing blood loss and the subsequent need for transfusion, and we have now standardized the practice.”
TXA is a synthetic derivative of the amino acid lysine that produces antifibrinolytic activity by competitively inhibiting lysine binding sites on plasminogen molecules. TXA helps the body stabilize blood clot formation, thereby reducing bleeding at surgical sites.
Most protocols of TXA in total joint arthroplasty have involved intravenous delivery. However, studies have indicated that topical injection may provide advantages, such as potentially reduced costs with a single injection, surgeon control, and localization and concentration of the drug more precisely at the surgical site.
“As the evidence for topical TXA grew, our arthroplasty surgeons started adopting topical TXA for total joint arthroplasty,” Dr Froehlich said.
He and his colleagues studied topical TXA in patients undergoing primary hip or knee arthroplasty by 5 surgeons from March 2012 to March 2013. Of the 591 consecutive patients, 311 received topical TXA, and 280 served as controls.
The researchers found that topical TXA reduced the proportion of red blood cell units transfused by 18%, from 28.6% to 10.6% (P<0.001). The drug also reduce the number of patients who required transfusions by 12%, from 17.5% to 5.5% (P<0.001).
On, the other hand, there was no significant difference between the TXA and control groups with regard to tourniquet time, operative time, time in the operating room, or the length of hospital stay.
Still, more patients in the TXA arm than in the control arm were able to go home rather than to a subacute nursing facility—71.4% and 62.1%, respectively (P<0.02).
And TXA conferred a cost benefit based solely on the rate of transfusion reduction. The researchers’ cost analysis revealed a net savings of $8372.66 per 100 patients treated, which amounted to $83.73 per patient.
“[Topical TXA] reduces transfusion rates, increases home disposition, and reduces cost in primary hip and knee arthroplasty,” said study author Lee Rubin, MD, of The Miriam Hospital.
“[W]e have now developed a simple, standardized, and cost-effective protocol for the use of topical TXA during total joint replacement that can be immediately used by any surgeon around the world to improve patient care.”