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This study was designed to examine whether tranexamic acid, which is a well-established therapy to reduce postoperative bleeding, is associated with adverse events in patients at high risk for a thrombotic event undergoing total joint arthroplasty (TJA). While there is good trial data supporting the use of tranexamic acid in “low-risk” patients undergoing TJA, the authors wanted to address the limited data supporting the use of tranexamic acid in “high-risk” patients undergoing TJA.

Using data from a large healthcare system, the study was able to identify 38 220 patients undergoing TJA eligible for their study. They identified “high-risk” patients as anyone having a history of DVT, PE, MI, stroke, a prothrombotic state (Factor V Leiden, Protein C or S deficiency, or antiphospholipid antibody syndrome), atrial fibrillation, atrial flutter, CABG, or coronary artery stent. The primary outcome of the study was a composite outcome that included the occurrence of MI, stroke, PE, DVT, death, or readmission within 90 days of TJA.

When comparing “high-risk” patients who did and did not receive tranexamic acid, the authors found that patients who DID NOT receive tranexamic acid had a higher rate of DVT, PE, MI, stroke, hospital readmission and 90-day mortality than patients who did receive tranexamic acid. These results were strengthened by the authors’ use of a multivariable model which also found no association between tranexamic acid administration in high-risk patients and adverse events compared to low-risk patients receiving tranexamic acid. The authors conclude that their data supports the use of tranexamic acid in high-risk patients undergoing TJA without concern for adverse events.

– Micah T. Prochaska (SABM reviewer)