Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

Authors

James E. Baker, Saint Michael's Hospital University of Toronto
Katerina Pavenski, Saint Michael's Hospital University of Toronto
Razak A. Pirani, Saint Michael's Hospital University of Toronto
Alexander White, Saint Michael's Hospital University of Toronto
Mark Kataoka, Saint Michael's Hospital University of Toronto
James P. Waddell, Saint Michael's Hospital University of Toronto
Alexander Ho, Saint Michael's Hospital University of Toronto
Emil H. Schemitsch, Saint Michael's Hospital University of Toronto
Nick Lo, Saint Michael's Hospital University of Toronto
Earl R. Bogoch, Saint Michael's Hospital University of Toronto
Antoine Pronovost, Saint Michael's Hospital University of Toronto
Katherine Luke, Saint Michael's Hospital University of Toronto
Alanna Howell, Saint Michael's Hospital University of Toronto
Anna Nassis, Saint Michael's Hospital University of Toronto
Albert K.Y. Tsui, Saint Michael's Hospital University of Toronto
Rosa Maria Tanzini, Saint Michael's Hospital University of Toronto
Robisa Pulendrarajah, Saint Michael's Hospital University of Toronto
C. David Mazer, Saint Michael's Hospital University of Toronto
John Freedman, Saint Michael's Hospital University of Toronto
Gregory M.T. Hare, Saint Michael's Hospital University of Toronto

Document Type

Article

Publication Date

11-1-2015

Journal

Canadian Journal of Anesthesia

Volume

62

Issue

11

First Page

1179

Last Page

1187

URL with Digital Object Identifier

10.1007/s12630-015-0460-6

Abstract

© 2015, Canadian Anesthesiologists' Society. Purpose: Tranexamic acid (TXA) therapy can reduce red blood cell (RBC) transfusion; however, this therapy remains underutilized in many surgical patient populations. We assessed whether implementation of a protocol to facilitate universal administration of TXA in patients undergoing total hip or knee arthroplasty would reduce the incidence of RBC transfusion without increasing adverse clinical outcomes. Methods: We implemented a quality of care policy to provide universal administration of intravenous TXA at a dose of 20 mg·kg−1iv to all eligible patients undergoing total hip or knee arthroplasty from October 21, 2013 to April 30, 2014. We compared data from an equal number of patients before and after protocol implementation (n = 422 per group). The primary outcome was RBC transfusion with secondary outcomes including postoperative hemoglobin concentration (Hb) and length of hospital stay. Adverse events were identified from the electronic medical records. Data were analyzed by a Chi square test and adjusted logistic and linear regression analysis. Results: Implementation of the protocol resulted in an increase in TXA utilization from 45.8% to 95.3% [change 49.5%; 95% confidence interval (CI), 44.1 to 54.5; P < 0.001]. This change was associated with a reduction in the rate of RBC transfusion from 8.8% to 5.2%, (change −3.6%; 95% CI, −0.1 to −7.0; P = 0.043). Pre- and post-protocol mean [standard deviation (SD)] Hb values were similar, including the nadir Hb prior to RBC transfusion [72 (8) g·L−1vs 70 (8) g·L−1, respectively; mean difference −1 g·L−1; 95% CI, −3 to 5; P = 0.569]. Length of stay was not altered, and no increase in adverse events was observed. Conclusions: Implementation of a perioperative TXA protocol was associated with both an increase in TXA use and a reduction in RBC transfusion following hip or knee arthroplasty. Adverse events and length of hospital stay were not influenced by the protocol.

Notes

Article is freely available from the journal