title: Does tranexamic acid alter the risk of thromboembolism following primary total knee arthroplasty with sequential earlier anticoagulation? A large, single center, prospective cohort study of consecutive cases.
abstract: BACKGROUND
  In order to decrease the blood loss and transfusion requirement, tranexamic acid (TXA) has attracted the public's attention in total knee arthroplasty (TKA). However, the safety profile of TXA hindered its wide adoption. And the balance of anti-coagulation sequential anti-fibrinolysis has not yet been explored. This large, single center, prospective cohort study of consecutive cases aimed to investigate the epidemiology of vascular occlusive events associated with TXA and introduce our preliminary results of novel thromboprophylaxis.
  
  
  METHODS
  We prospectively collected patients' data of our institution through National Health Database. The primary outcome was the incidence of venous thromboembolism and mortality within 30days following primary TKA. Subgroup analysis was performed on the basis of TXA administration methods.
  
  
  RESULTS
  During 2012 to 2014, a total of 2532 unilateral TKA procedures were conducted in our institution, 2222 with TXA, 310 without TXA. The total occurrence of vascular occlusive events was statistically significantly higher (17.55% Vs 9.35%, p<0.001) in the TXA group but this finding was confined to the calf veins, with the main difference being the incidence in the calf muscular veins (13.68% Vs 6.77%, p=0.001). Statistical difference was not detected neither in the incidence of symptomatic DVT nor asymptomatic DVT. No episode of symptomatic PE and all-cause mortality within 30days occurred postoperatively. Subgroup analysis revealed no significant difference with regard to the incidence of DVT (p>0.05).
  
  
  CONCLUSIONS
  This study confirmed that the incidence of postoperative VTE was unchanged when TXA was administered in primary unilateral TKA. And our study further indicated that earlier anticoagulation should be adopted to keep the balance between anti-fibrinolysis and anti-coagulation after administering TXA.
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Pengde
authors.initials: P
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Zongke
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, Republic of People, China. Electronic address: peifuxinghuaxi@126.com.
authors.forename: Fuxing
authors.initials: F
authors.lastname: Pei
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Total knee arthroplasty; anti-coagulation; anti-fibrinolysis; venous thromboembolism