Tranexamic Acid Should be Considered for High Risk Arthroplasty Patients


  • Andy Ho Western Health
  • David Campbell Centre for Orthopaedic and Trauma Research, University of Adelaide; The Queen Elizabeth Hospital;
  • Shanil Yapa St John of God Hospital (Murdoch)
  • Ibrahim Malek Wrexham Maelor Hospital
  • Pier Yates Centre for Orthopaedic and Trauma Research; Fiona Stanley Hospital



TXA, Tranexamic acid, Arthroplasty, VTE, Venothromboembolism, Joint replacement



Tranexamic acid significantly reduces blood loss and transfusion requirements in arthroplasty patients.  However, it is often avoided in patients who have had previous arterial and thromboembolic disease despite the absence of evidence of hazard in this group of patients. We examined the use of tranexamic acid in unselected hip and knee arthroplasty patients including those considered to be ‘high risk’.



A 2-year retrospective multicentre study was performed with patients who underwent hip or knee arthroplasty surgery. A blood management protocol included universal tranexamic acid use for all patients. Blood loss, transfusion volumes and complications were analysed.



A total of 958 patients were included in the study, 130 patients were considered ‘high risk’ of thromboembolic complications and 828 patients were considered ‘low risk’. 879 patients received tranexamic acid with a significant reduction in blood loss (p<0.001) in these patients.

Two of 130 (1.5%) ‘high risk’ patients and 14 of 828 (1.7%) ‘low risk’ patients had post-operative VTE. There was no significant difference in rate of VTE between the ‘high risk’ and ‘low risk’ patients (p=0.6) or in the subgroup of ‘high risk’ patients who had received TXA (p=1).



The efficacy of tranexamic acid is overwhelming and outweighs any potential risks. Tranexamic acid should be considered for use in all arthroplasty patients including those with prior history of venous or arterial thrombosis.

Author Biographies

Andy Ho, Western Health

Orthopaedic Registrar

MD, BBiomed, DipAnat


David Campbell, Centre for Orthopaedic and Trauma Research, University of Adelaide; The Queen Elizabeth Hospital;

Associate Professor

Consultant Orthopaedic Surgeon


Shanil Yapa, St John of God Hospital (Murdoch)

Orthopaedic Registrar


Ibrahim Malek, Wrexham Maelor Hospital


Consultant Orthopaedic Surgeon


Pier Yates, Centre for Orthopaedic and Trauma Research; Fiona Stanley Hospital


Consultant Orthopaedic Surgeon



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How to Cite

Ho, A., Campbell, D., Yapa, S., Malek, I., & Yates, P. (2022). Tranexamic Acid Should be Considered for High Risk Arthroplasty Patients . Reconstructive Review, 12(1).



Original Article