Tranexamic Acid in Total Joint Arthroplasty
Jan 1, 2019
Tranexamic Acid in Total Joint Arthroplasty: The Endorsed Clinical Practice Guides of AAHKS, ASRA, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society
From Fillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. Reg Anesth Pain Med. 2019;44:7–11. doi: 10.1136/rapm-2018-000024
Hip and knee arthroplasties are routine orthopedic procedures commonly associated with acute postoperative anemia, and in many cases require an allogeneic or autologous blood transfusion. Several techniques have been used to limit postoperative blood loss and risk of transfusion. Tranexamic acid (TXA) is an antifibrinolytic agent that has fundamentally changed blood management in total joint arthroplasty (TJA) by making transfusion an infrequent event. Although TXA is widely used in total hip arthroplasty (THA) and total knee arthroplasty (TKA), it has not yet become the standard of care. A significant body of literature has been compiled on the use of TXA in hip and knee arthroplasty but a comprehensive review and analysis of the existing evidence to provide clinical guidance is lacking. Therefore, the American Association of Hip and Knee Surgeons (AAHKS), the American Academy of Orthopaedic Surgeons (AAOS), the Hip Society, the Knee Society and the American Society of Regional Anesthesia and Pain Medicine (ASRA) have worked together to develop evidence-based guidelines on the use of TXA in primary TJA. The purpose of these guidelines is to improve the treatment of orthopedic surgical patients and reduce practice variation by promoting a multidisciplinary evidence-based approach on the use of TXA. The combined clinical practice guidelines are meant to address common and important questions related to the efficacy and safety of TXA in primary TJA. Using the AAOS Clinical Practice Guidelines and Systematic Review Methodology, the committee members completed a series of direct meta-analyses and network meta-analyses to support the clinical practice guidelines.1 For each question, we have provided a recommendation, assessed the strength of the recommendation and elaborated on the rationale of the recommendation, which should be interpreted in accordance with the AAOS Clinical Practice Guidelines and Systematic Review Methodology. 1 The current clinical practice guidelines were based on the available evidence, so future updates may become necessary as additional literature becomes available with future research.