Background Tranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature.
Methods After institutional review board approval, we queried a large national database to identify patients who had undergone total hip and total knee arthroplasties (2012–2016). Patients were divided based on their exposure to TXA and history of seizures. The main outcome of interest was a perioperative seizure. We conducted univariable comparisons and a multivariable regression analysis to elucidate a potential independent association between TXA administration and seizures in the perioperative period (with or without a history of seizures).
Results TXA was used overall in 45.9% (n=4 21 890) of joint arthroplasty recipients (n=9 18 918), with more frequent use over time. Utilization rates did not differ between those with and without a history of seizures; 42.2% (3487/8252) of patients with a seizure history received TXA. Rates of perioperative seizure were low and did not differ between those who did and did not receive TXA (0.01% vs 0.02%, p=0.11); when subgrouping patients by history of seizures, we found no difference in incidence of perioperative seizures between groups (0.06% vs 0.02%, p=0.39). Our adjusted analysis further confirmed these results.
Conclusion Despite increasing TXA utilization in total joint arthroplasty, we found an overall low seizure incidence. TXA use was not associated with elevated odds of perioperative seizure, even in patients with history of seizure.
- surgical outcome
- pharmacology: other
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Contributors MAK: Study design/planning, interpretation of results, and manuscript preparation and review. LAW: Study design/planning, data analysis, interpretation of results, and manuscript preparation and review. MF: Study design/planning, interpretation of results, and manuscript review. JP: Helped in study design/planning, interpretation of results, and manuscript preparation and review. JL: Study design/planning, interpretation of results, and manuscript review. SGM: Study design/planning, interpretation of results, and manuscript preparation and review.
Funding This study was funded internally by the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.
Competing interests SGM is a director on the boards of the ASRA and the Society of Anesthesia and Sleep Medicine (SASM). He is a one-time consultant for Sandoz and Teikoku and is currently on the medical advisory board of HATH. He has a pending US Patent application for a Multicatheter Infusion System (US Patent US-2017-0361063). He is the owner of SGM Consulting and co-owner of FC Monmouth.
Patient consent for publication Not required.
Ethics approval This retrospective cohort study was approved by the Institutional Review Board of Hospital for Special Surgery (IRB No: 2012-050).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data are available through a data use agreement with Premier Healthcare to access the Premier Healthcare database.