04 Sep Universal TXA During Hip/Knee Replacement Reduced Transfusions 40%

MedicalResearch.com Interview with:
Dr. Gregory M.T. Hare MD PhD
Department of Anesthesia
St. Michael’s Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Hare: While many randomized trials had demonstrated that tranexamic acid (TXA therapy) was effective at reducing surgical blood loss and red blood cell transfusion in patients undergoing hip and knee replacement surgery, our hospital and many other centers in Ontario were not fully utilizing this therapy. Part of the reason was a concern about drug safety and potential side effects. While no serious adverse events had been reported using TXA, we set out to assess the impact of a protocol designed to ensure that we administered TXA (20 mg/kg iv preoperatively) to all eligible patients undergoing hip and knee replacement and determining the effect on our red blood cell transfusion rate and adverse effects including blood clot, stroke, heart attack, kidney injury and death. We excluded patients at high risk of any thrombotic complication.

After implementing our protocol, we increased utilization of the drug from 46% to 95% of eligible patients. With this increase in TXA use, we observed a 40% reduction in red blood cell transfusion. The impact was greater in patients with pre-operative anemia, but was also effective in non-anemic patients. The threshold for transfusion was not different after initiating our protocol and patients were discharged with higher red blood cell counts. Length of hospital stay remained constant and the incidence of adverse events did not increase.

Medical Research: What should clinicians and patients take away from your report?

Dr. Hare: Universal administration of TXA in patients undergoing hip or knee replacement surgery is safe and effective at reducing the incidence of red blood cell transfusion.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hare: We plan to continue following our patients over time and have now accumulated data on about 2000 patients. We continue to observe reduced rates of red blood cell transfusion and no increase in adverse events. As part of our ongoing quality assurance program, we have developed a computer based real-time database to continue collecting data on patients who receive TXA peri-operatively ; to ensure that transfusion rates remain low and that no increase in adverse events are observed over time.

Citation:

James E. Baker, Katerina Pavenski, Razak A. Pirani, Alexander White, Mark Kataoka, James P. Waddell, Alexander Ho, Emil H. Schemitsch, Nick Lo, Earl R. Bogoch, Antoine Pronovost, Katherine Luke, Alanna Howell, Anna Nassis, Albert K. Y. Tsui, Rosa Maria Tanzini, Robisa Pulendrarajah, C. David Mazer, John Freedman, Gregory M. T. Hare. Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 2015; DOI: 10.1007/s12630-015-0460-6

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Dr. Gregory M.T. Hare MD PhD (2015). Universal TXA During Hip/Knee Replacement Reduced Transfusions 40% 

Last Updated on September 4, 2015 by Marie Benz MD FAAD