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Tranexamic acid is safe and effective in patients with heterozygous factor V Leiden mutation during total joint arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Patients with an inherent hypercoagulable state are at a higher risk of venous thromboembolism (VTE) following total joint arthroplasty (TJA). Further administration of tranexamic acid (TXA) during TJA may increase the risk of VTE in these high-risk patients. There is no study that specifically analyzes the safety and efficacy of TXA during TJA in patients with factor V Leiden (FVL) mutation; therefore, the purpose of this study was to evaluate the safety and efficacy of TXA use on the risk of VTE and bleeding in patients carrying FVL mutation.

Materials and methods

A total of 42 patients with FVL mutation (22 hips, 20 knees) and 40 control patients (20 hips, 20 knees) who underwent TJA were retrospectively reviewed. All patients received 1 g TXA intravenously 15 min before the skin incision and 2 g of TXA was administered locally at the surgical site as a periarticular injection. Pharmacological thromboprophylaxis (low-molecular-weight heparin) was administered to all patients. Estimated blood loss and in-hospital thromboembolic complications were compared between the groups.

Results

In both total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients, there was no significant difference in the amount of estimated blood loss among the groups (p = 0.980, and p = 0963, respectively). None of the patients in the THA group received a blood transfusion. The transfusion rate was similar in the TKA group (p = 0.756, one patient in each group). No VTE, myocardial infarction, or any other complications related to TXA use were observed in any of the patients.

Conclusions

The combined local and systemic administration of TXA could be safely used in patients with heterozygous FVL mutation receiving pharmacological thromboprophylaxis during TJA without increasing the risk of VTE.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Ali Levent, Philip Linke, Thorsten Gehrke & Mustafa Citak

  2. Department of Orthopedics and Traumatology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Health Sciences University, Şanlıurfa, Turkey

    Ali Levent

  3. Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey

    Ozkan Kose

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  1. Ali Levent
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  2. Ozkan Kose
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Correspondence to Ali Levent.

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Conflict of interest

The authors declare that they have no conflict of interest regarding this manuscript. Independent from the submitted manuscript, Dr. Gehrke received payments from the following companies: Waldemar Link, Zimmer Biomet, Heraeus Ceramtec. Dr. Citak received payments from the following company: Waldemar Link.

Ethical approval

This study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and the institutional review board approved the study protocol (approval date/issue: June 5, 2020/WF-070/20).

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Consent to participate and/or consent to publish was waived due to the retrospective nature of the study.

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Levent, A., Kose, O., Linke, P. et al. Tranexamic acid is safe and effective in patients with heterozygous factor V Leiden mutation during total joint arthroplasty. Arch Orthop Trauma Surg 143, 613–620 (2023). https://doi.org/10.1007/s00402-021-04110-9

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  • DOI: https://doi.org/10.1007/s00402-021-04110-9

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