Does tranexamic acid alter the risk of thromboembolism after total hip arthroplasty in the absence of routine chemical thromboprophylaxis?
Tranexamic acid (TXA) has been used to reduce blood loss during total hip arthroplasty (THA), but its use could increase the risk of venous thromboembolic disease (VTE). Several studies have reported that TXA does not increase the prevalence of deep vein thrombosis (DVT), but most of those used routine chemical thromboprophylaxis, thereby masking the potential increased risk of TXA on VTE. We wished to ascertain whether TXA increases the prevalence of VTE in patients undergoing THA without routine chemical thromboprophylaxis. We carried out a retrospective case-control study in 254 patients who underwent a primary THA, 127 of whom received TXA (1 g given pre-operatively) and a control group of 127 who did not. All patients had mechanical but no chemical thomboprophylaxis. Each patient was examined for DVT by bilateral ultrasonography pre-operatively and on post-operative days 1 and 7. TXA was found to statistically significantly increase the incidence of total DVT on post-operative day 7 compared with the control group (24 (18.9%) and 12 (9.4%), respectively; p < 0.05) but most cases of DVT were isolated distal DVT, with the exception of one patient with proximal DVT in each group. One patient in the control group developed a non-fatal symptomatic pulmonary embolism (PE). The use of TXA did not appear to affect the prevalence of either proximal DVT or PE.
['Nishihara|S|S|', 'Hamada|M|M|']
D000368:Aged D000933:Antifibrinolytic Agents D019644:Arthroplasty, Replacement, Hip D016022:Case-Control Studies D005260:Female D006621:Hip Joint D006801:Humans D007592:Joint Diseases D008297:Male D008875:Middle Aged D015995:Prevalence D012189:Retrospective Studies D012306:Risk D013923:Thromboembolism D014148:Tranexamic Acid D014463:Ultrasonography D020246:Venous Thrombosis
tranexamic acid total hip arthroplasty deep venous thrombosis