Tranexamic Acid Was Safe in Arthroplasty Patients With a History of Venous Thromboembolism: A Matched Outcome Study

Background In contemporary total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), intravenous tranexamic acid (IV TXA) has proved efficacious in decreasing blood loss and transfusion. Interested in expanding the use of IV TXA to patients with a prior venous thromboembolic event (VTE), we sought out to determine the risk of recurrent VTE with TXA administration during primary THA and TKA. Methods We retrospectively reviewed 1262 patients (1620 cases) with a history of VTE who underwent primary THA or TKA between 2000 and 2012. IV TXA was given in 258 (16%) of the cases and not given in 1362 (84%). VTE rates were evaluated at 90 days postoperatively. Given the rarity of recurrent VTEs, patients who experienced a recurrent VTE were 2:1 retrospectively matched against patients in the cohort with a history of VTE who did not experience a recurrent VTE using age (±5 years), sex, body mass index (±5 kg/m²), American Society of Anesthesiologist score, and type of chemoprophylaxis. Results VTE recurrence was not significantly greater in those who received TXA (2.3%; 6/258) compared to those who did not receive TXA (1.8%; 25/1362; P =.6). When the 31 patients who experienced a recurrent VTE were 2:1 matched to control patients, IV TXA was not associated with any increase in the risk of recurrent VTE (odds ratio, 0.9; P =.9). Conclusion Patients with a history of VTE had a low risk of recurrent VTE (2%) after contemporary THA and TKA, and that rate was not increased with the use of IV TXA.