Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty
Abstract Background The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This...
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| Veröffentlicht in: | The Journal of arthroplasty 2017-04, Vol.32 (4), p.1298-1303 |
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| creator | Madsen, Rune Vinther, MD Nielsen, Christian Skovgaard, MD Kallemose, Thomas, MSc Husted, Henrik, MD, DMSc Troelsen, Anders, MD, PhD, DMSc |
| description | Abstract Background The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences and predictors of TE events after routine administration of IV TXA in THA and TKA. Methods 3,159 THA or TKA procedures performed from 2007-2013 at our institution were included. IV TXA, 1 g, was administered preoperatively if not contraindicated. Relevant patient characteristics and comorbidity information were extracted locally from the database. Data on TE events occurring within 90 days postoperatively came from The Danish National Patient Registry . Patient characteristics, comorbidities and TE events were compared between TXA groups. A logistic regression model was used to evaluate predictors of TE events. Results Of 3,159 procedures, 2,766 (=87.6%) received TXA (TXA+ group) preoperatively, while 393 (=12.4%) did not (TXA- group). Mean age, distributions of gender, ASA score, anesthesia method, duration of surgery, diagnosis and survival status were all statistically significant different (p-values |
| doi_str_mv | 10.1016/j.arth.2016.10.015 |
| format | Article |
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However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences and predictors of TE events after routine administration of IV TXA in THA and TKA. Methods 3,159 THA or TKA procedures performed from 2007-2013 at our institution were included. IV TXA, 1 g, was administered preoperatively if not contraindicated. Relevant patient characteristics and comorbidity information were extracted locally from the database. Data on TE events occurring within 90 days postoperatively came from The Danish National Patient Registry . Patient characteristics, comorbidities and TE events were compared between TXA groups. A logistic regression model was used to evaluate predictors of TE events. Results Of 3,159 procedures, 2,766 (=87.6%) received TXA (TXA+ group) preoperatively, while 393 (=12.4%) did not (TXA- group). Mean age, distributions of gender, ASA score, anesthesia method, duration of surgery, diagnosis and survival status were all statistically significant different (p-values<0.05) between TXA groups. The studied comorbidities were all significantly different (TXA+ versus TXA- group) (p-values ≤0.002). We found 31 (1.0%) TE events out of 3,159 procedures, with no significant group difference in TE events (TXA+: 27 out of 2,766=1.0%, TXA-: 4 out of 393=1.0%, p-value=0.55 for any event). For the TXA+ group, 0.5% suffered from deep venous thrombosis, 0.3% from acute myocardial infarction and 0.2% from a pulmonary embolism. In the TXA+ group higher age (OR=1.06, 95%CI=1.02-1.11, p=0.005) and present cardiovascular disease (OR=4.78, 95%CI=1.72-13.28, p=0.003) were associated with an increased risk of TE events. Conclusion The findings suggest routine use of IV TXA for TKA and THA as safe with low occurrence of TE events, although a large prospective trial should confirm this.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2016.10.015</identifier><identifier>PMID: 27843042</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Administration, Intravenous ; Aged ; Aged, 80 and over ; Anesthesia - adverse effects ; Antifibrinolytic Agents - administration & dosage ; Antifibrinolytic Agents - adverse effects ; arthroplasty ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Knee - adverse effects ; complications ; Female ; hip ; Humans ; knee ; Male ; Middle Aged ; Orthopedics ; Postoperative Period ; Pulmonary Embolism - etiology ; Retrospective Studies ; Risk ; safety ; Thromboembolism - chemically induced ; tranexamic acid ; Tranexamic Acid - administration & dosage ; Tranexamic Acid - adverse effects ; Venous Thrombosis - etiology</subject><ispartof>The Journal of arthroplasty, 2017-04, Vol.32 (4), p.1298-1303</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-34cfd25f5b29a65b5ae4c60ddbec35ff33a1382e64f6757281f17ef45d76b2453</citedby><cites>FETCH-LOGICAL-c411t-34cfd25f5b29a65b5ae4c60ddbec35ff33a1382e64f6757281f17ef45d76b2453</cites><orcidid>0000-0002-1944-1936</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arth.2016.10.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27843042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Madsen, Rune Vinther, MD</creatorcontrib><creatorcontrib>Nielsen, Christian Skovgaard, MD</creatorcontrib><creatorcontrib>Kallemose, Thomas, MSc</creatorcontrib><creatorcontrib>Husted, Henrik, MD, DMSc</creatorcontrib><creatorcontrib>Troelsen, Anders, MD, PhD, DMSc</creatorcontrib><title>Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Abstract Background The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences and predictors of TE events after routine administration of IV TXA in THA and TKA. Methods 3,159 THA or TKA procedures performed from 2007-2013 at our institution were included. IV TXA, 1 g, was administered preoperatively if not contraindicated. Relevant patient characteristics and comorbidity information were extracted locally from the database. Data on TE events occurring within 90 days postoperatively came from The Danish National Patient Registry . Patient characteristics, comorbidities and TE events were compared between TXA groups. A logistic regression model was used to evaluate predictors of TE events. Results Of 3,159 procedures, 2,766 (=87.6%) received TXA (TXA+ group) preoperatively, while 393 (=12.4%) did not (TXA- group). Mean age, distributions of gender, ASA score, anesthesia method, duration of surgery, diagnosis and survival status were all statistically significant different (p-values<0.05) between TXA groups. The studied comorbidities were all significantly different (TXA+ versus TXA- group) (p-values ≤0.002). We found 31 (1.0%) TE events out of 3,159 procedures, with no significant group difference in TE events (TXA+: 27 out of 2,766=1.0%, TXA-: 4 out of 393=1.0%, p-value=0.55 for any event). For the TXA+ group, 0.5% suffered from deep venous thrombosis, 0.3% from acute myocardial infarction and 0.2% from a pulmonary embolism. In the TXA+ group higher age (OR=1.06, 95%CI=1.02-1.11, p=0.005) and present cardiovascular disease (OR=4.78, 95%CI=1.72-13.28, p=0.003) were associated with an increased risk of TE events. Conclusion The findings suggest routine use of IV TXA for TKA and THA as safe with low occurrence of TE events, although a large prospective trial should confirm this.</description><subject>Administration, Intravenous</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia - adverse effects</subject><subject>Antifibrinolytic Agents - administration & dosage</subject><subject>Antifibrinolytic Agents - adverse effects</subject><subject>arthroplasty</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>complications</subject><subject>Female</subject><subject>hip</subject><subject>Humans</subject><subject>knee</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Postoperative Period</subject><subject>Pulmonary Embolism - etiology</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>safety</subject><subject>Thromboembolism - chemically induced</subject><subject>tranexamic acid</subject><subject>Tranexamic Acid - administration & dosage</subject><subject>Tranexamic Acid - adverse effects</subject><subject>Venous Thrombosis - etiology</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9rFDEUx4Modq3-Ax4kRy-z5ufMLIiwlGrFBaHWc8gkLzTbmWRNMq3735txqwcPHkLC4_t5vHweQq8pWVNC23f7tU7lds3quxbWhMonaEUlZ00vSPsUrUjf80YKws_Qi5z3hFAqpXiOzljXC04EW6Gwiw_42uc7HB2-uU1xGiLUM3qDL-8hlIy3rkDC13EuPgDe2skHn0vSxcfwm0o6wE89VWJrvMU-4Ct_wDpY_CVAJeqQKR5GncvxJXrm9Jjh1eN9jr5_vLy5uGp2Xz99vtjuGiMoLQ0XxlkmnRzYRrdykBqEaYm1AxguneNcU94zaIVrO9mxnjragRPSdu3AhOTn6O2p7yHFHzPkoiafDYxjHTXOWdGebzq-6VtWo-wUNSnmnMCpQ_KTTkdFiVo8q71aPKvF81Krniv05rH_PExg_yJ_xNbA-1MA6i_vPSSVjYdgwPoEpigb_f_7f_gHN2PVbvR4B0fI-zinUP0pqjJTRH1bNr0smracdIIS_gvfYqQH</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Madsen, Rune Vinther, MD</creator><creator>Nielsen, Christian Skovgaard, MD</creator><creator>Kallemose, Thomas, MSc</creator><creator>Husted, Henrik, MD, DMSc</creator><creator>Troelsen, Anders, MD, PhD, DMSc</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1944-1936</orcidid></search><sort><creationdate>20170401</creationdate><title>Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty</title><author>Madsen, Rune Vinther, MD ; Nielsen, Christian Skovgaard, MD ; Kallemose, Thomas, MSc ; Husted, Henrik, MD, DMSc ; Troelsen, Anders, MD, PhD, DMSc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-34cfd25f5b29a65b5ae4c60ddbec35ff33a1382e64f6757281f17ef45d76b2453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Administration, Intravenous</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia - adverse effects</topic><topic>Antifibrinolytic Agents - administration & dosage</topic><topic>Antifibrinolytic Agents - adverse effects</topic><topic>arthroplasty</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>complications</topic><topic>Female</topic><topic>hip</topic><topic>Humans</topic><topic>knee</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Postoperative Period</topic><topic>Pulmonary Embolism - etiology</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>safety</topic><topic>Thromboembolism - chemically induced</topic><topic>tranexamic acid</topic><topic>Tranexamic Acid - administration & dosage</topic><topic>Tranexamic Acid - adverse effects</topic><topic>Venous Thrombosis - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Madsen, Rune Vinther, MD</creatorcontrib><creatorcontrib>Nielsen, Christian Skovgaard, MD</creatorcontrib><creatorcontrib>Kallemose, Thomas, MSc</creatorcontrib><creatorcontrib>Husted, Henrik, MD, DMSc</creatorcontrib><creatorcontrib>Troelsen, Anders, MD, PhD, DMSc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madsen, Rune Vinther, MD</au><au>Nielsen, Christian Skovgaard, MD</au><au>Kallemose, Thomas, MSc</au><au>Husted, Henrik, MD, DMSc</au><au>Troelsen, Anders, MD, PhD, DMSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>32</volume><issue>4</issue><spage>1298</spage><epage>1303</epage><pages>1298-1303</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Abstract Background The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retrospective study investigates patient characteristics, occurrences and predictors of TE events after routine administration of IV TXA in THA and TKA. Methods 3,159 THA or TKA procedures performed from 2007-2013 at our institution were included. IV TXA, 1 g, was administered preoperatively if not contraindicated. Relevant patient characteristics and comorbidity information were extracted locally from the database. Data on TE events occurring within 90 days postoperatively came from The Danish National Patient Registry . Patient characteristics, comorbidities and TE events were compared between TXA groups. A logistic regression model was used to evaluate predictors of TE events. Results Of 3,159 procedures, 2,766 (=87.6%) received TXA (TXA+ group) preoperatively, while 393 (=12.4%) did not (TXA- group). Mean age, distributions of gender, ASA score, anesthesia method, duration of surgery, diagnosis and survival status were all statistically significant different (p-values<0.05) between TXA groups. The studied comorbidities were all significantly different (TXA+ versus TXA- group) (p-values ≤0.002). We found 31 (1.0%) TE events out of 3,159 procedures, with no significant group difference in TE events (TXA+: 27 out of 2,766=1.0%, TXA-: 4 out of 393=1.0%, p-value=0.55 for any event). For the TXA+ group, 0.5% suffered from deep venous thrombosis, 0.3% from acute myocardial infarction and 0.2% from a pulmonary embolism. In the TXA+ group higher age (OR=1.06, 95%CI=1.02-1.11, p=0.005) and present cardiovascular disease (OR=4.78, 95%CI=1.72-13.28, p=0.003) were associated with an increased risk of TE events. Conclusion The findings suggest routine use of IV TXA for TKA and THA as safe with low occurrence of TE events, although a large prospective trial should confirm this.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27843042</pmid><doi>10.1016/j.arth.2016.10.015</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-1944-1936</orcidid></addata></record> |
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| subjects | Administration, Intravenous Aged Aged, 80 and over Anesthesia - adverse effects Antifibrinolytic Agents - administration & dosage Antifibrinolytic Agents - adverse effects arthroplasty Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects complications Female hip Humans knee Male Middle Aged Orthopedics Postoperative Period Pulmonary Embolism - etiology Retrospective Studies Risk safety Thromboembolism - chemically induced tranexamic acid Tranexamic Acid - administration & dosage Tranexamic Acid - adverse effects Venous Thrombosis - etiology |
| title | Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty |
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