Journal of clinical orthopaedics and trauma · 2026
Complication rates after intraoperative tranexamic acid use in total joint arthroplasty patients with a history of solid organ transplantation: A retrospective cohort study.
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Saba Braden V, Shanaa Jean, Khury Farouk, Masrouha Karim, Rozell Joshua C, Schwarzkopf Ran
Аннотация
BACKGROUND: Solid organ transplant (SOT) recipients undergoing total joint arthroplasty (TJA) may face elevated perioperative risk because of chronic immunosuppression, medical comorbidity, and organ-specific physiologic considerations. Although intravenous tranexamic acid (TXA) is widely used during TJA to reduce perioperative blood loss, evidence regarding outcomes among SOT recipients receiving TXA remains limited.
METHODS: A retrospective review was performed of 29,240 consecutive primary TJA patients who all received intraoperative intravenous TXA between June 2011 and March 2025. Patients undergoing unicompartmental knee arthroplasty, hemiarthroplasty, TJA for fracture, bilateral procedures, revision procedures, or those with less than 90 days of postoperative follow-up were excluded. SOT history was identified using diagnosis and procedural codes and verified by manual review. Outcomes included 90-day deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), operative time, and hospital length of stay (LOS).
RESULTS: Sixty-six patients with verified SOT were identified. The most common transplant types were kidney (59%), liver (24%), and heart (9%). One SOT patient experienced a 90-day VTE event compared with 95 control patients (1.5% versus 0.3%, P = 0.20). There were no PEs or MIs in the SOT cohort, compared with PE and MI rates of 0.2% and 0.01% in controls, respectively (P > 0.05 for both). Operative times were similar between groups (100.8 versus 108.5 min, P = 0.11), while LOS was significantly longer among SOT recipients (86.2 versus 43.8 h, P < 0.001).
CONCLUSION: In this retrospective cohort of primary TJA patients who all received intraoperative intravenous TXA, SOT recipients had low observed rates of VTE, PE, and MI. Because all patients received TXA and the SOT cohort was small, these findings should be interpreted as comparative observational safety data rather than evidence that TXA independently increases or does not increase thromboembolic risk in this population.
METHODS: A retrospective review was performed of 29,240 consecutive primary TJA patients who all received intraoperative intravenous TXA between June 2011 and March 2025. Patients undergoing unicompartmental knee arthroplasty, hemiarthroplasty, TJA for fracture, bilateral procedures, revision procedures, or those with less than 90 days of postoperative follow-up were excluded. SOT history was identified using diagnosis and procedural codes and verified by manual review. Outcomes included 90-day deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), operative time, and hospital length of stay (LOS).
RESULTS: Sixty-six patients with verified SOT were identified. The most common transplant types were kidney (59%), liver (24%), and heart (9%). One SOT patient experienced a 90-day VTE event compared with 95 control patients (1.5% versus 0.3%, P = 0.20). There were no PEs or MIs in the SOT cohort, compared with PE and MI rates of 0.2% and 0.01% in controls, respectively (P > 0.05 for both). Operative times were similar between groups (100.8 versus 108.5 min, P = 0.11), while LOS was significantly longer among SOT recipients (86.2 versus 43.8 h, P < 0.001).
CONCLUSION: In this retrospective cohort of primary TJA patients who all received intraoperative intravenous TXA, SOT recipients had low observed rates of VTE, PE, and MI. Because all patients received TXA and the SOT cohort was small, these findings should be interpreted as comparative observational safety data rather than evidence that TXA independently increases or does not increase thromboembolic risk in this population.