Tranexamic Acid Is Safe in Patients with a History of Corona
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TXA is gradually being used to reduce blood loss during complete joint arthroplasty (TJA). While TXA has been shown to be effective in minimizing surgical blood loss, many surgeons believe it increases the risk of myocardial infarction in patients with coronary artery disease (CAD) or a history of coronary stents. The aim of this research was to see whether TXA could be used safely in patients with a history of coronary artery disease or stents.

Researchers performed a retrospective analysis at a single, tertiary academic medical center identifying consecutive total hip and knee arthroplasty cases over an 8-year period. From this cohort who received TXA intraoperatively, patients with a history of CAD or coronary stents were identified and determined the total myocardial infarction and venous thromboembolism (VTE) rates within a 90-day postoperative period.

Chi-square analysis were used to identify differences in VTE rates between cohorts. A post hoc power analysis was also performed to determine whether our results were powered to detect a difference in VTE rates.

Results:
--In the 26,808 identified at-risk patients, there were no postoperative myocardial infarctions. No significant differences were observed for VTE rates compared with the control cohort using either topical or intravenous TXA, with regard to CAD (0.29% compared with 0.76%) or coronary stents (0% compared with 0.76%).

--Moreover, there was no significant difference observed in VTE rates when administration was subcategorized into intravenous and topical methods with regard to CAD (0.13% compared with 0.72%) or coronary stents (0% compared with 0%).

In conclusion, as compared to the control group, topical and intravenous TXA is similarly healthy when used in patients with a history of CAD and coronary stents. Intravenous TXA was recommended because it has the same effectiveness and risk of adverse events as oral TXA and could be easier to introduce in institutions.

Source: https://www.jbjs.org/reader.php?id=207221&rsuite_id=2771108&native=1&topics=hp kn&source=The_Journal_of_Bone_and_Joint_Surgery/Publish+Ahead+of+Print//10.2106/JBJS.20.01226/abstract#info
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