Topical intra articular tranexamic acid reduces packed blood cell consumption in total joint arthroplasty.

INTRODUCTION: post-operative blood loss anemia is an undesired event following total joint arthroplasty. Use of tranexamic acid (TXA) has been shown to reduce blood loss after surgery and can be administered intravenously, orally and topically. We assessed the effect of topical intra articular TXA administration at the end of surgery in total joint arthroplasty on post-operative packed blood cell units' consumption. OBJECTIVE: assess the effect of topical intra-articular TXA administration in reduction of packed blood cell units' consumption postoperatively. MATERIAL AND METHODS: this is a retrospective study comparing two groups of patients that had either a primary total knee arthroplasty (TKA) or primary total hip arthroplasty (THA) during a four months' period before and after the beginning of intra articular administration of a solution containing 2 grams of TXA. Pre-operative hemoglobin level, post-operative day one hemoglobin level, packed blood cell administration and venous thromboembolism events (VTE) were assessed. RESULTS: a total of 282 patients were reviewed, 148 records of patients that had a TKA and 134 records of patients that had THA. There were 80 and 68 TKA without and with TXA administration, respectively. There were 84 and 50 THA without and with TXA administration, respectively. There was no difference between the groups with regard to preoperative anticoagulation and aspirin treatment and VTE risk assessment. There was also no difference regarding preoperative hemoglobin levels. Patients undergoing THA and TKA showed a significant decrease in the hemoglobin level between preoperative levels to hemoglobin on post-operative day. However, administration of TXA ameliorated this decrease in hemoglobin levels, from 2.77 to 2.18 g/dl in hip arthroplasty (p < 0.001) and from 2.92 to 1.72 g/dl in knee arthroplasty (p < 0.001). In the THA group 13 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). In the TKA group 15 packed blood cell units were administered without TXA compared to two units in patients treated with TXA (p < 0.001). There were no VTE events in the THA patients. In the TKA patients, pulmonary embolism was diagnosed in two patients not treated with TXA and in three patients that were treated with intra articular TXA (p = 0.66). CONCLUSION: intra-articular topical administration of TXA at the end of surgery significantly reduced need for post-operative packed blood cell units' administration without increases in VTE risk in all patients undergoing primary THA and TKA.