Study finds, Role of Tranexamic Acid for Complications in Ar
Preoperative coagulopathy is a risk factor for perioperative blood loss. The antifibrinolytic effects of tranexamic acid (TXA) could negate the association between preoperative coagulopathy and adverse outcomes in patients undergoing total joint arthroplasty (TJA). This study compared the perioperative outcomes of coagulopathic TJA patients who did and did not receive TXA.

Researchers retrospectively reviewed 2,123 primary TJAs performed in patients with a preoperative coagulopathy. Coagulopathy was defined as international normalized ratio more than 1.2, partial thromboplastin time more than 35 seconds, or platelet count less than 150,000/microL. TXA was administered in 240 patients and not administered in 1,883 patients.

--Patients who received TXA had less intraoperative blood loss and 2.3 times decreased risk of 90-day complications, especially cardiovascular (2.92% vs. 12.1%) and wound complications (0.0% vs. 1.59%).

--TXA was also associated with shorter length of stay (beta 0.74) and decreased risk of non-home discharge (OR 0.50). There was no difference in mortality or 90-day readmissions between the groups.

TXA treatment, in conclusion, reduced the frequency of perioperative problems and resource use in arthroplasty patients who had a preoperative coagulopathy detected by preadmission testing. These data support the use of TXA in patients having TJA, especially when the patient has a preoperative coagulopathy.