Your nameFriend's name
Your emailFriend's email

Intravenous tranexamic acid and lower limb arthroplasty—a randomised controlled feasibility study

Department of Anaesthesia, Royal Adelaide Hospital and Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia

Summary

Tranexamic acid (TA) is widely reported to reduce bleeding and the risk of blood transfusion in patients undergoing lower limb arthroplasty. No study in this setting has had adequate power to examine for the effect of TA on either uncommon, but clinically important, adverse events or patient-centric endpoints. A large randomised controlled trial (RCT) is required to address these questions. As a preliminary feasibility study, we conducted an investigator-initiated, prospective, randomised, double blind placebo-controlled trial in 140 patients, aged 45 years or older, undergoing elective primary or revision hip or knee joint replacement. Subjects were randomised to receive intravenous (IV) TA or a placebo. The primary endpoints were the proportion of patients receiving allogenic blood transfusion and the feasibility of extending our trial methodology to a large trial of TA in this population. Secondary endpoints included a range of adverse clinical and surgical events as well as several patient-centric questionnaires. Red blood cell transfusion occurred in 15% of all patients prior to discharge from hospital. Transfusion rates were significantly different between the TA and placebo groups (8.5% versus 21.7%, P=0.03). Three out of four feasibility endpoints were met, with recruitment being slower than expected. No significant differences were seen between groups in the secondary endpoints. Despite a lower rate of transfusion than that widely reported, IV TA reduced transfusion in patients undergoing lower limb arthroplasty. Our trial methodology would be feasible in the setting of a large multicentre study to investigate whether TA is safe and reduces bleeding in lower limb arthroplasty.

ASA member / Anaesthesia and Intensive Care subscriber

If you are a member of the ASA or subscribe to the Anaesthesia and Intensive Care Journal please login to view entire article.

Purchase 24-hour access

If you are not a member, you may purchase 24-hour access to the entire article by simply selecting your country and clicking the 'Purchase' button below.

Select your country:

Purchase a subscription

For unlimited access to all articles, you can subscribe to the Anaesthesia and Intensive Care Journal.