Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty

• Main Authors: Philip G. Ghobrial BS, Daniel Schmitt, Nicholas M. Brown, Michael S. Pinzur MD, Adam P. Schiff MD
• Format: Article
• Language: English
• Published: SAGE Publishing 2020-10-01
• Series: Foot & Ankle Orthopaedics
• Online Access: https://doi.org/10.1177/2473011420S00226

Category: Ankle; Other Introduction/Purpose: Tranexamic acid (TXA) has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty (TAA). In light of expanding indications for TAA and its growing utilization, there is a need for more data regarding interventions such as TXA that may reduce perioperative complications and improve patient outcomes for this procedure. The purpose of the current study was to determine if the use of TXA in patients undergoing total ankle arthroplasty impacts the blood loss or overall complication rate. Methods: A retrospective chart review was conducted for 34 patients who underwent TAA with (n=17) and without (n=17) intraoperative TXA from 2016 to 2019 at a single academic medical center. Inclusion criteria were patients who underwent TAA for any clinical indication and had quantified intraoperative blood loss. Patients were excluded if they had a contraindication to TXA (ie. impaired renal function), a history of coagulopathy, no recorded intraoperative blood loss, or intraoperative complications that resulted in excessive bleeding. Estimated blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss and complication rates were recorded and compared between groups. Statistical analysis was performed using SPSS 21.0. Results: There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference or hidden blood loss between the groups (all, p>0.05). A lower rate of wound complications was observed in the TXA group. The difference between the overall complications rates observed for each group was not statistically significant (p>0.05). Conclusion: Intravenous tranexamic acid did not result in decreased blood loss during TAA, as measured in our study. However, tranexamic acid was not associated with any increase in overall complications while a lower rate of wound complications was seen in patients in which TXA was utilized. Based on our findings, further studies are needed to better elucidate the impact of TXA on blood loss and wound healing in TAA.