Abstract
Background
While tranexamic acid (TXA) has been well shown to reduce blood loss after joint replacement surgery, little is known regarding its effectiveness in obese patients. The aim of this study was to evaluate the effect of TXA on packed red blood cell (PRBC) blood transfusion rates and change in hemoglobin (HGB) and hematocrit (HCT) for obese patients undergoing joint replacement at our institution.
Material and methods
Between January and December 2014, 117 consecutive primary joint replacements (THA n=23; TKA n=94) were performed in obese patients (BMI ≥ 30kg/m2) by two surgeons. Medical records were reviewed and identified that TXA was utilized in 45 (38.5%) arthroplasties. TXA was given intravenously (IV) in two doses: (1) one gram prior to incision and (2) one gram at the time of femoral preparation in THA or prior to cementation in TKA. Topical TXA was utilized in cases where IV TXA was contraindicated. PRBC transfusion rates, changes in HBG and HCT, and occurrence of thrombolytic events were recorded from hospital records.
Results
There was no difference in the mean BMI between the group that received TXA and those that did not (36.3±4.6 kg/m2 vs. 37.8±6.6kg/m2; p=0.184). The mean operative time for the TXA group (110.1±42.1 min)was significantly longer than group that did not receive TXA (94.5±32.2 min) (p<0.026). Both the incidence (11.1% vs. 34.7%) and total number (7 vs. 51) of PRBC blood transfusions were significantly reduced with TXA use (p=0.005). The change in HBG (2.7 ± 1.3 g/dl vs. 3.6 ±1.3 g/dl) and the change in HCT (4.5±3.5% vs. 9.7±4.6%) were significantly reduced in the group that received TXA (p<0.001and p<0.001, respectively). Two pulmonary emboli were reported in the group that did not receive TXA, whereas no thrombolytic events were reported in the group that did receive TXA.
Conclusion
The use of TXA in obese patients undergoing total joint arthroplasty significantly reduced the number of PRBC blood transfusions, change in HGB and HCT and was not associated with any thrombolytic events.
