TRANEXAMIC ACID PROVIDES SIGNIFICANT COST BENEFIT AND REDUCED BLOOD LOSS IN PRIMARY HIP AND KNEE ARTHROPLASTY.

Abstract

Primary hip and knee replacements can be associated with significant blood loss. Tranexamic acid is a fibrinolytic inhibitor that has been shown to significantly reduce blood loss and transfusion requirement in hip and knee replacement, however the cost-benefit has not been widely investigated.

Our study involved 100 patients, comprising a prospective cohort of 50 consecutive primary hip and knee replacements (treatment group) and a control group of the preceding 50 patients undergoing the same surgery. All knee replacements were computer navigated. The prospective cohort all had tranexamic acid 1g intravenously at the time of surgery, repeated at 8 and 16 hours. All patients had 28 days thromboprophylaxis with subcutaneous low-molecular-weight-heparin.

The control group comprised 24 hip replacements and 26 knees versus 17 hips and 33 knees in the treatment group. Autologous transfusion drains were used in the control group knee replacements and the mean volume reinfused was 458ml. These drains were only used in the first 15 knee replacements in the treatment group as only one patient drained enough for reinfusion (100ml; p< 0.001). The mean fall in haemoglobin in the control group post surgery was 3.4g/dl versus 2.3g/dl in the treatment group (p< 0.001). Seven patients were transfused in the control group (14 units of red cells) versus two in the treatment group (5 units).

The potential cost saving per patient averaged across all joints in the treatment group is £102.51. This is a function of savings in transfusion, cessation of drains for re-infusion in knee replacement and the cost of tranexamic acid.

The only thromboembolic event was 1 deep vein thrombosis in the treatment group.

Our data shows the cost savings associated with the use of tranexamic acid in primary hip and knee surgery are considerable and supports its use to significantly reduce blood loss and transfusion requirement.