Tranexamic Acid Reduces Costs, Shortens Hospital Stay After Total Knee Replacement

By John Henry Dreyfuss, staff.

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  • Intra-articular tranexamic acid (TXA) reduces costs, transfusion rates, and length of hospital stay in patients undergoing total knee arthroplasty (TKA).
  • Blood transfusion rates were significantly lower when TXA was used.
  • Reduced transfusion rates and shorter hospital stays resulted in significantly lower costs.
  • Amount of blood transfused was significantly lower in cases where TXA was used.
  • TXA was infused directly into the knee joint via an epidural catheter following wound closure.
  • Overall cost saving was AU$631.36 (US$479.88) per patient.

Intra-articular tranexamic acid (TXA) (Figure 1) use can significantly reduce costs associated with total knee arthroplasty (TKA). Use of TXA results in decreased blood transfusion rate and decreased volume of transfused blood. It was also associated with decreased length of hospital stay in patients undergoing TKA, according to the results of a study—“Clinical and Financial Benefits of Intra-Articular Tranexamic Acid in Total Knee Arthroplasty”—published recently in the Journal of Orthopaedic Surgery.

Figure 1. Tranexamic acid.

The authors of this retrospective study aimed to examine a number effects of the use of intra-articular TXA for TKA (Figures 2 and 3). Specifically, they endeavored to examine the effects of intra-articular TXA administered before wound closure on the volume of blood lost during surgery, the volume of transfused blood in the perioperative period, and the length of hospital stay. The study was conducted at 4 institutions in Australia during the period from 2009 to 2014.


Figure 2. An x-ray image of a replaced knee joint.



Figure 3. Total knee arthroplasty.

Surgeons have used a number of strategies to reduce the number of blood transfusions associated with TKA as well as the volume of blood transfused. Besides the increasing costs associated with a higher number of blood transfusions and greater volumes of blood transfused, transfusion is also associated with a number of untoward clinical effects including blood-borne infection, potential disease transmission, hemolysis, anaphylaxis, and death, as well as the further treatment associated with these negative outcomes.

The Analysis

The authors reviewed records on 1981 patients (mean age, 69.2 years) who underwent primary TKA with (n=1006) or without (n=975) TXA. All surgeries were conducted by 1 of 4 knee arthroplasty surgeons. Tranexamic acid (3000 mg/30mL) was administered via an epidural catheter directly into the knee joint after wound closure. Patients with hemoglobin levels of <80g/dL on postop days 1and 2, or those with symptoms of acute anemia, received blood transfusion.

The review revealed that intra-articular TXA use following TKA resulted in a reduced rate of blood transfusion (4.5% [45/1006] vs. 14.8% [144/975], P<0.0001). Tranexamic acid administration also resulted in fewer units of blood transfused (86 vs. 313 units, P<0.0001), fewer units of blood transfused per 100 patients (8.5 vs. 32.1, P<0.0001), and shortened length of hospital stay (4.7±2.3 vs. 5.3±2.7 days, P<0.0001).

Results and Conclusions

Total cost savings with respect to the reduction in blood transfusion was AU$143.68 (US$109.23) per patient. When the change in length of hospital stay and TXA costs were included, the overall saving was AU$631.36 per patient. The number of units of blood transfused per patient was highly significantly reduced from 32.1 to 8.5. The length of hospital stay was reduced from 5.3 to 4.7 days when TXA was used.


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