Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2015; 6(11): 977-982
Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.977
Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study
Niall P McGoldrick, Eabhann M O’Connor, Nikos Davarinos, Rose Galvin, John F Quinlan
Niall P McGoldrick, Eabhann M O’Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland
Rose Galvin, Department of Clinical Therapies, University of Limerick, Castletroy, Limerick V94 T9PX, Ireland
Author contributions: McGoldrick NP contributed to the design of the study, analysis and interpretation of data, and writing of the manuscript; O’Connor EM contributed to the data collection; Davarinos N contributed to the drafting of the manuscript; Galvin R contributed to the analysis of data and drafting of the manuscript; Quinlan JF contributed to the conception and design of the study, interpretation of data, and drafting of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Tallaght Hospital Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Niall P McGoldrick, MB, MCh, MRCSI, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Belgard Square North, Dublin D24 NR0A, Ireland.
Telephone: +353-1-4142000 Fax: +353-1-4144779
Received: May 28, 2015
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.

Keywords: Arthroplasty, Hip, Knee, Tranexamic acid, Cost-benefit analysis

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.