Background and Aims Over the past years, tranexamic acid (TXA) has been used extensively to reduce blood loss during total joint arthroplasty (TJA).¹ However, questions remain in respect to the risk of cardiac ischemic events, especially in those with coronary artery disease. We aimed to study if the use of TXA is associated with increased risk of myocardial infarction (MI) among 1) the overall population who underwent TJA, and 2) the population who had coronary artery disease before TJA.

Methods This study is approved by Hospital for Special Surgery Institutional Review Board (IRB# 2016–436). We used Premier Healthcare database to identify patients undergoing TJA from 2006–2019, and their history of stent placement or coronary artery bypass graft (CABG) procedures. The primary exposure was intravenous TXA administration, and outcome is perioperative MI. Multilevel multivariable logistic regression models were performed to identify if TXA use was associated with perioperative MI.

Results Out of all patients who underwent TJA, 44.7% received TXA. Upon adjusting for all covariates, patients who received TXA had a 30% lower odds of having MI compared to patients without TXA. After restricting the cohort to patients who received stent placements/CABG surgery before TJA, TXA administration was not significantly associated with perioperative MI. (Table 1)

Conclusions In conclusion, we found that patients who received TXA were less likely to experience MI events in the TJA population. For patients who had coronary procedures before their joint arthroplasty, the use of TXA was not associated with an increase in the odds for MI.