title: Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety.
abstract: OBJECTIVE
  To determine the effectiveness and safety of perioperative tranexamic acid use in patients undergoing total hip or knee arthroplasty in the United States.
  
  
  METHODS
  Retrospective cohort study; multilevel multivariable logistic regression models measured the association between tranexamic acid use in the perioperative period and outcomes.
  
  
  METHODS
  510 US hospitals from the claims based Premier Perspective database for 2006-12.
  
  
  METHODS
  872,416 patients who had total hip or knee arthroplasty.
  
  
  METHODS
  Perioperative intravenous tranexamic acid use by dose categories (none, ≤ 1000 mg, 2000 mg, and ≥ 3000 mg).
  
  
  METHODS
  Allogeneic or autologous transfusion, thromboembolic complications (pulmonary embolism, deep venous thrombosis), acute renal failure, and combined complications (thromboembolic complications, acute renal failure, cerebrovascular events, myocardial infarction, in-hospital mortality).
  
  
  RESULTS
  While comparable regarding average age and comorbidity index, patients receiving tranexamic acid (versus those who did not) showed lower rates of allogeneic or autologous transfusion (7.7% v 20.1%), thromboembolic complications (0.6% v 0.8%), acute renal failure (1.2% v 1.6%), and combined complications (1.9% v 2.6%); all P<0.01. In the multilevel models, tranexamic acid dose categories (versus no tranexamic acid use) were associated with significantly (P<0.001) decreased odds for allogeneic or autologous blood transfusions (odds ratio 0.31 to 0.38 by dose category) and no significantly increased risk for complications: thromboembolic complications (odds ratio 0.85 to 1.02), acute renal failure (0.70 to 1.11), and combined complications (0.75 to 0.98).
  
  
  CONCLUSIONS
  Tranexamic acid was effective in reducing the need for blood transfusions while not increasing the risk of complications, including thromboembolic events and renal failure. Thus our data provide incremental evidence of the potential effectiveness and safety of tranexamic acid in patients requiring orthopedic surgery.
authors.affiliation: Institute of Healthcare Delivery Science, Mount Sinai Hospital System / Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
authors.affiliation: Institute of Healthcare Delivery Science, Mount Sinai Hospital System / Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rehana
authors.initials: R
authors.lastname: Rasul
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
authors.forename: Suzuko
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Danninger
authors.affiliation: Institute of Healthcare Delivery Science, Mount Sinai Hospital System / Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
authors.forename: Mathias
authors.initials: M
authors.lastname: Opperer
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA memtsoudiss@hss.edu.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
mesh_terms: D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced; D011655:Pulmonary Embolism / Q000139:chemically induced; D013223:Statistics as Topic; D020521:Stroke / Q000139:chemically induced; D014148:Tranexamic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid