PROVIDENCE, R.I. – Orthopedic surgeons from The Miriam Hospital have conducted a cost-benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients that revealed a 12 percent transfusion rate reduction – from 17.5 percent to 5.5 percent – with no significant difference in complication rates. In addition to reducing the risk for postoperative bleeding and transfusion following total joint replacement, use of topical TXA enabled approximately 9.3 percent more patients to be discharged to home rather than to a skilled nursing facility. The study and its findings have been published in print in The Journal of Arthroplasty.
“Historically, with hip or knee replacement, there was a 25 to 30 percent chance of a blood transfusion,” says John Froehlich, M.D., program director of the Total Joint Center at The Miriam Hospital and a principal investigator on the study. “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.”
The reduction of perioperative blood transfusions in total joint arthroplasty has been an ongoing goal in the effort to deliver more efficient and effective health care. According to several studies, blood transfusions may add a 3 to 20 percent risk of postoperative infection. Perioperative transfusion adds both cost to the procedure and risk to the patient, including joint infection, allergic reaction and viral transmission, which led to The Miriam’s analysis of topical TXA in primary hip and knee arthroplasty.