SLR - October 2022 - Alan Lazzar, DPM
Title: The efficacy and safety of intravenous tranexamic acid on blood loss during total ankle replacement: a retrospective studyReference: Tan G, Xie LW, Yi SJ, Chen Y, Liu X, Zhang H. The efficacy and safety of intravenous tranexamic acid on blood loss during total ankle replacement: a retrospective study. Sci Rep. 2022 Jun 9;12(1):9542. doi: 10.1038/s41598-022-13861-3. PMID: 35680960; PMCID: PMC9184638.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Alan Lazzar, DPM
Residency Program: Carl T. Hayden Veterans' Administration Medical Center – Phoenix, Arizona
Podiatric Relevance: Total ankle replacement (TAR) has become an effective method of treating end-stage ankle arthritis. Tranexamic acid (TXA) has been used to reduce perioperative blood loss in orthopedic surgery. Very few studies have discussed whether TXA has the same benefits during total ankle replacements as hip and knee replacements. The authors in this study hypothesized that TXA reduced perioperative blood loss without increasing the risk of symptomatic venous thromboembolism (VTE) during TAR.
Methods: This was a retrospective study using 71 patients who underwent TAR using the INBONE II at the same hospital by the same ankle surgeon between January 2017 through May 2021. The treatment group consisted of 33 patients receiving intravenous TXA; 38 patients in the control group did not. The following outcome measures were obtained 2 weeks, 1 month, 3 months, 6 months and 12 months after the operation: estimated intraoperative blood loss, hemoglobin (Hb) and hematocrit (HCT) of preoperatively and 72 hours postoperatively, hidden blood loss, total blood loss, incidence of symptomatic VTE, early wound complication occurrence, American Orthopedic Foot and Ankle Society (AOFAS) scores, and ankle range of motion.
Results: No statistically significant difference of preoperative level of Hb and HCT were detected between the two groups. However, a significant difference of postoperative 72 h level of Hb and HCT were detected. The TXA group showed lower estimated intraoperative blood loss, hidden blood loss, total blood loss and Hb decrease than the control group. The average AOFAS score and ROM of pre-operation between the two groups have no significant difference. 1 month after the operation, the average AOFAS score in the TXA group were significantly higher than those in the control group. No statistically significant difference in the average AOFAS score between the two groups were found from 3 months to 1 year post-op. Similarly, the ROM in the TXA group were significantly higher than those in the control group one month after surgery. And no statistical significance from 3 months to 1 year after the operation in the average AOFAS score between the two groups.
Conclusions: Overall, this article found that usage of TXA can reduce perioperative blood loss in patients undergoing TAR without increasing the risk of VTE. Early stage ankle range of motion and patient quality of life was improved with TXA administration. The retrospective nature of this design allows for potential selection bias; prospective randomized control trials are needed for future studies with larger sample sizes. TXA should be used more frequently during total ankle replacements for the patients’ benefit.