Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis

Sagar Telang, BS; Ryan Palmer, BS; Andrew Dobitsch, MD; Jacob R. Ball, MD; Nathanael D. Heckmann, MD; Jay R. Lieberman, MD

Arthroplasty Today (Dec 2024)

Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis

Sagar Telang, BS,
Ryan Palmer, BS,
Andrew Dobitsch, MD,
Jacob R. Ball, MD,
Nathanael D. Heckmann, MD,
Jay R. Lieberman, MD

Affiliations

Sagar Telang, BS: Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
Ryan Palmer, BS: Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
Andrew Dobitsch, MD: Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
Jacob R. Ball, MD: Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
Nathanael D. Heckmann, MD: Corresponding author. Keck Medical Center of USC, Department of Orthopaedic Surgery, 1520 San Pablo Street, Ste 2000, Los Angeles, CA 90333, USA. Tel.: +1 323 704 6363.; Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
Jay R. Lieberman, MD: Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

Journal volume & issue: Vol. 30
p. 101548

Abstract

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Background: This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events. Methods: The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts. Results: In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, P < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, P < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, P < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, P < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, P = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, P = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, P = .564). Conclusions: Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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