Key result
Perioperative TXA linked to ~17% fewer bleeding complications in apixaban patients without increasing thromboembolic risk.
Why the study?
To investigate whether perioperative tranexamic acid reduces postoperative bleeding without increasing thromboembolic events in total joint arthroplasty patients receiving apixaban for thromboprophylaxis.
Does perioperative tranexamic acid reduce the risk of postoperative bleeding without increasing thromboembolic events in total joint arthroplasty patients receiving apixaban for thromboprophylaxis?
Cohort (n=118,219)
Yes
Does perioperative tranexamic acid reduce the risk of postoperative bleeding without increasing thromboembolic events in total joint arthroplasty patients receiving apixaban for thromboprophylaxis?
Perioperative administration of tranexamic acid in total joint arthroplasty patients receiving apixaban reduces bleeding complications without increasing thromboembolic risk.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in apixaban-treated arthroplasty patients; leaves open confirmation of bleeding benefit without thrombotic harm in RCTs.
Abstract 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.
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Telang et al. (2024) conducted a cohort in Primary elective total knee or hip arthroplasty (n=118,219). Tranexamic acid (TXA) vs. No TXA (apixaban alone) was evaluated on Aggregate bleeding complications (aOR 0.83, 95% CI 0.81-0.86, p=< .001). Perioperative TXA in total joint arthroplasty patients receiving apixaban reduced aggregate bleeding complications without increasing thromboembolic risk.
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