Tranexamic acid lowers transfusions and readmissions in high-risk total knee arthroplasty patients, but neurologic risks remain in patients with seizures or visual disturbances

IF 5.5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-07-02 Epub Date: 2025-10-27 DOI:10.1002/ksa.70124

Joshua R. Porto, Monish S. Lavu, Christian J. Hecht II, Olivia G. Asimakis, David C. Kaelber, Atul F. Kamath

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引用次数: 0

Abstract

Purpose

Tranexamic acid (TXA) is widely used in total knee arthroplasty (TKA) to reduce perioperative blood loss and transfusions. However, its safety in high-risk patients remains uncertain. This study evaluates TXA's safety and efficacy in TKA patients with a history of (1) thromboembolic events, (2) renal failure, (3) atrial fibrillation, (4) seizures and (5) visual disturbances.

Methods

A retrospective analysis of the US Collaborative Network within TriNetX examined TKA patients from 2017 to 2023 (n = 59,057). High-risk patients were categorised by preexisting risk factors and propensity-score matched into TXA and non-TXA groups. Postoperative outcomes, including thromboembolic events, transfusions, renal failure, seizures, visual disturbances, infections, revisions, readmissions and mortality, were compared using odds ratios (OR) with 95% confidence intervals (CIs).

Results

TXA was associated with lower transfusion rates, revisions, readmissions and emergency visits across multiple risk groups. No increased risk of deep vein thrombosis (DVT) or (PE) was observed in patients with prior thrombosis, renal failure, or atrial fibrillation, though ischaemic stroke/transient ischaemic attack (TIA) was higher in those with prior thrombosis (5.6% vs. 3.9%, OR: 1.44, 95% CI: 1.24–1.68). Patients with seizures had higher rates of postoperative seizures (10.4% vs. 7.1%, OR: 1.53, 95% CI: 1.18–1.99) and pulmonary embolism (1.9% vs. 1.0%, OR: 2.02, 95% CI: 1.06–3.85). In those with visual disturbances, TXA was linked to increased postoperative seizures (0.9% vs. 0.4%, OR: 1.97, 95% CI: 1.21–3.19) and visual disturbances (4.2% vs. 3.3%, OR: 1.29, 95% CI: 1.07–1.57).

Conclusions

TXA reduced transfusions, readmissions and revisions in high-risk TKA patients without increasing DVT or PE risk, though there was a modest increase in stroke/TIA for patients with prior thromboembolism. However, higher postoperative neurologic complications in patients with seizures or visual disturbances warrant further investigation. While TXA can provide benefits across several outcomes, discretion is advised in patients with neurological risk factors to optimise safety.

Level of Evidence

Level III retrospective cohort study.

查看原文本刊更多论文

氨甲环酸降低了高风险全膝关节置换术患者的输血和再入院率，但癫痫发作或视力障碍患者的神经系统风险仍然存在。

目的：氨甲环酸（TXA）被广泛应用于全膝关节置换术（TKA），以减少围手术期的失血和输血。然而，其在高危患者中的安全性仍不确定。本研究评估TXA在有以下病史的TKA患者中的安全性和有效性：(1)血栓栓塞事件，(2)肾功能衰竭，(3)心房颤动，(4)癫痫发作和(5)视力障碍。方法：对TriNetX内的美国合作网络进行回顾性分析，检查了2017年至2023年的TKA患者（n = 59,057）。高危患者按先前存在的危险因素和倾向评分匹配分为TXA组和非TXA组。术后结果，包括血栓栓塞事件、输血、肾衰竭、癫痫发作、视力障碍、感染、修复、再入院和死亡率，使用95%置信区间（ci）的优势比（OR）进行比较。结果：在多个危险组中，TXA与较低的输血率、修订、再入院和急诊就诊相关。有血栓、肾功能衰竭或房颤病史的患者发生深静脉血栓（DVT）或（PE）的风险未见增加，但有血栓病史的患者发生缺血性卒中/短暂性缺血发作（TIA）的风险较高（5.6% vs. 3.9%, or: 1.44, 95% CI: 1.24-1.68）。癫痫发作患者术后癫痫发作的发生率较高（10.4% vs. 7.1%, OR: 1.53, 95% CI: 1.18-1.99）和肺栓塞（1.9% vs. 1.0%, OR: 2.02, 95% CI: 1.06-3.85）。在有视觉障碍的患者中，TXA与术后癫痫发作增加（0.9% vs. 0.4%, OR: 1.97, 95% CI: 1.21-3.19）和视觉障碍（4.2% vs. 3.3%, OR: 1.29, 95% CI: 1.07-1.57）有关。结论：TXA减少了高风险TKA患者的输血、再入院和翻修，而没有增加DVT或PE的风险，尽管先前有血栓栓塞的患者的卒中/TIA略有增加。然而，癫痫发作或视力障碍患者的术后神经并发症较高，值得进一步研究。虽然TXA可以在多种结果中提供益处，但建议在有神经危险因素的患者中谨慎使用，以优化安全性。证据等级：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).