Abstract
Introduction
Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but data is limited in the revision setting. The purpose of the current study was to compare the rate of blood transfusions and symptomatic venous thromboembolic events (VTEs) in a large cohort of revision THAs treated with or without IV TXA.
Methods
We performed a retrospective review of 3,264 revision THAs (2,645 patients) between 2005–2014, of which 1,142 patients received IV TXA (1g at incision and 1g at closure). The mean age was 65 years with 49% males in the revision group with TXA, and 67 years with 45% males in the revision group treated without TXA. Outcomes analyzed included rates of transfusion and VTE (within 90 days) between cases treated with TXA and cases not treated with TXA. These comparisons were performed for the overall cohort, as well as within the subset of aseptic cases and septic cases. In order to minimize potential bias between these two subgroups, the analyses were weighted with inverse probability of treatment weights based on a propensity score which included age at revision THA, sex, BMI, ASA score, preoperative anticoagulation, and year of surgery. Mean follow-up was 2 years.
Results
Tranexamic acid significantly reduced the rate of blood transfusions after revision THA overall from 54% to 26% (p<0.001; unadjusted RR 2.1, adjusted RR 1.6), with a significant reduction in both septic (73% to 53%, p = 0.04) and aseptic (49% to 18%, p<0.001) revisions. The rate of VTE was minimal overall, with 3 events (0.3%) in the group with TXA and 4 events (0.2%) in the group without TXA. Similarly, there were no significant differences in VTE rates in those who did or did not receive IV TXA based upon the procedures being septic or aseptic in nature.
Conclusions
Intravenous TXA significantly reduced transfusion rates during all-cause revision THAs, including a subgroup analysis of both aseptic and septic cohorts. Adjusted risk utilizing inverse probability of treatment weights based on a propensity model showed no statistical difference in rates of VTEs between either group.
Summary
The use of IV TXA in revision THAs is associated with a significant reduction in transfusion rates, and a very low rate of VTEs (0.3%).
