For patients with a history of coronary artery disease or coronary stents who undergo total joint arthroplasty, use of topical and intravenous tranexamic acid is safe, according to published results.
Researchers from the department of orthopedic surgery at NYU Langone Health retrospectively analyzed results of 26,808 patients who received tranexamic acid (TXA) while undergoing either THA or TKA from June 2011 to September 2019. Of the cohort, 1,028 patients had a history of coronary artery disease (CAD) and 288 patients had coronary stents. According to the study, outcomes measures included total myocardial infarction and venous thromboembolism (VTE) rates within a 90-day postoperative period.
Overall, there were no reported postoperative myocardial infarctions in any cohort. Researchers found VTE rates were higher among the control cohort (0.76%) compared with the CAD cohort (0.29%) and the coronary stent cohort (0%); however, this difference was not significant. Additionally, no significant difference was observed in VTE rates between patients who underwent TJA using either IV TXA (0.13%) or topical TXA (0.72%).
“In this series, topical and intravenous TXA were equally safe when used in patients with a history of CAD and coronary stents in comparison with the control cohort,” the researchers wrote in the study. “With equal efficacy and risk of adverse events, we recommend intravenous TXA, which may enable easier institutional implementation.”