Topical tranexamic acid can be used safely even in high risk patients: deep vein thrombosis examination using routine ultrasonography of 510 patients

Abstract

Background: Previous studies regarding tranexamic acid (TXA) in total knee arthroplasty (TKA) investigated only symptomatic deep vein thrombosis (DVT) or did not include high risk patients. The incidence of DVT including both symptomatic and asymptomatic complications after applying topical TXA has not been evaluated using ultrasonography. Methods: Medical records of 510 patients who underwent primary unilateral TKA between July 2014 and December 2017 were retrospectively reviewed. Because TXA was routinely applied through the topical route, those who had history of venous thromboembolism, myocardial infarction, or cerebral vascular occlusive disease were not excluded. Regardless of symptom manifestation, DVT was examined at 1 week postoperatively for all patients using ultrasonography, and postoperative transfusion rate was investigated. The study population was divided according to the use of topical TXA. After the two groups were matched based on the propensity scores, the incidence of DVT and the transfusion rate were compared between the groups. Results: Of the 510 patients comprising 298 patients in the TXA group and 212 patients in the control group, DVT was noted in 22 (4.3%) patients. Two patients had DVT proximal to the popliteal vein. After propensity score matching (PSM), 168 patients were allocated to each group. 11 patients in the TXA group and 7 patients in the control group were diagnosed with DVT, which did not show a significant difference (p=0.721). However, the two groups differ significantly in the transfusion rate (p<0.001, 50.0% in the TXA group, 91.7% in the control group). Conclusion: The incidence of DVT, whether symptomatic or asymptomatic, was not affected by the use of topical TXA. Postoperative transfusion rate was reduced in the TXA group. Topical TXA could be applied safely even in patients who had been known to be at high risk.