TXA in arthroplasty (Poeran)

Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety.

Poeran J, Rasul R, Suzuki S, et al. BMJ (Clinical research ed.) 2014 · PMID 25116268 · doi:10.1136/bmj.g4829

Question

Is tranexamic acid in hip and knee replacement associated with less transfusion without more thromboembolic complications?

Design

Large retrospective cohort using a US administrative database of hospitals.

Patients

Patients undergoing elective total hip or knee arthroplasty in US hospitals.

Intervention

Tranexamic acid

Comparison

No tranexamic acid

Primary outcome

Blood transfusion and thromboembolic and other complications

Key result

Tranexamic acid was associated with significantly lower transfusion rates, with no increase in thromboembolic events, acute renal failure or other complications.

Limitations

Observational design with possible residual confounding, and dose, route and timing of TXA were not standardised.

Impact on practice

Large-scale safety data that, together with trial evidence, underpins routine TXA use in hip replacement as recommended by NICE NG157.