Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.977
Peer-review started: June 1, 2015
First decision: August 4, 2015
Revised: August 14, 2015
Accepted: October 1, 2015
Article in press: October 8, 2015
Published online: December 18, 2015
AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.
METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.
RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.
CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.
Core tip: Worldwide the demand for lower limb arthroplasty procedures is increasing in the context of a diminishing economic climate. Total hip replacement and total knee replacement have traditionally been associated with large volume blood loss and the need for transfusion. Use of perioperative intravenous tranexamic acid (TXA) has been shown to be a cost effective measure, which reduces the need for transfusion. In this study, TXA was found to significantly reduce the number of patients requiring blood transfusion post-operatively, which has both clinical and economic significance.