Comparing Two Different Intravenous Regimens of Tranexamic Acid in Total Hip Arthroplasty, Total Knee Arthroplasty, and Total Shoulder Arthroplasty

Philadelphia

One significant intraoperative outcome of concern to anesthesiologists and orthopedic surgeons is controlling the amount of blood loss both intraoperatively and postoperatively. The use of the antifibrinolytic, tranexamic acid (TXA), is an innovative strategy that has been shown to decrease postoperative bleeding as well as decrease the need for blood transfusions. Currently, there are multiple intravenous tranexamic acid dose regimens that are being employed for orthopedic surgeries. In this study, the aim was to evaluate the effectiveness of a 2 dose regimen (1000 mg within 30 minutes pre-op and 1000 mg 4-6 hrs post-op) compared to a single 1000 mg preoperative IVPB dose. This study was a retrospective cohort conducted on patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA). Both TXA regimens resulted in similar transfusion rates and adverse event rates with no significant difference as determined by statistical analysis. Our results indicate that a single preoperative IVPB 1000 mg dose of TXA is a cost effective way to prevent blood loss and postoperative complications without increasing adverse events.