Deep Vein Thrombosis Rates in Total Hip Arthroplasty and Total Knee Arthroplasty on an Extended Course of Tranexamic Acid: A Retrospective Study

Background Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major elective orthopedic procedures associated with significant blood loss and a risk of symptomatic deep vein thrombosis (DVT). Tranexamic Acid (TXA), an antifibrinolytic agent, has shown efficacy in reducing blood loss and transfusion requirements, and the current literature suggests no increased risk of DVT. A recent study suggested extended length TXA resulted in improved recovery of range of motion. This review sought to determine the potential for increased DVT risk that might occur with extended duration TXA. Methods This retrospective cohort study included 957 consecutive patients who underwent primary THA (n = 381) or TKA (n = 576) between May 2023 and November 2024 who were not currently using prescription anti-coagulation. All patients received a regimen of 81 mg aspirin twice daily for 4 weeks and 1300 mg oral TXA once daily for 15 days postoperatively in addition to standard pre-op and post-op dosing regimen. Outcomes included the incidence of symptomatic DVT through 6 weeks and knee range of motion (ROM) at 2 and 6 weeks postoperatively in the TKA cohort. Statistical analysis was performed using SPSS with significance set at p < 0.05. Results The incidence of symptomatic DVT was 0.87% in the TKA group and zero in the THA group. In the TKA cohort, mean knee ROM improved from 110.52° ± 12.4° at 2 weeks to 120.2° ± 7.9° at 6 weeks. Conclusion Postoperative use of 1300 mg oral TXA for 15 days in patients undergoing TKA and THA does not appear to increase the risk of DVT compared to contemporary published DVT incidence. Secondary outcomes demonstrated favorable functional recovery in TKA patients, with improvements in knee ROM. Further research is needed to determine if these results are generalizable to all hip and knee arthroplasty patients.