Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications
Purpose: Total hip arthroplasty (THA) is an effective treatment for hip degenerative diseases; however, peri-operative blood loss often necessitates blood transfusion. Tranexamic acid (TXA) is widely used to reduce bleeding, although limited real-world evidence exists from Japanese populations. This...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
|
| Series: | Journal of Joint Surgery and Research |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949705125000179 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849222523194966016 |
|---|---|
| author | Hidetatsu Tanaka Kunio Tarasawa Yu Mori Kazuyoshi Baba Ryuichi Kanabuchi Yasuaki Kuriyama Hiroaki Kurishima Hideki Fukuchi Hiroki Kawamata Kiyohide Fushimi Toshimi Aizawa Kenji Fujimori |
| author_facet | Hidetatsu Tanaka Kunio Tarasawa Yu Mori Kazuyoshi Baba Ryuichi Kanabuchi Yasuaki Kuriyama Hiroaki Kurishima Hideki Fukuchi Hiroki Kawamata Kiyohide Fushimi Toshimi Aizawa Kenji Fujimori |
| author_sort | Hidetatsu Tanaka |
| collection | DOAJ |
| description | Purpose: Total hip arthroplasty (THA) is an effective treatment for hip degenerative diseases; however, peri-operative blood loss often necessitates blood transfusion. Tranexamic acid (TXA) is widely used to reduce bleeding, although limited real-world evidence exists from Japanese populations. This study assessed the association between peri-operative TXA use and transfusion requirements and complications using nationwide data. Methods: THA cases in the Japanese Diagnosis Procedure Combination (DPC) database from December 2011 to March 2023 were retrospectively analyzed. Patients undergoing primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis were included. One-to-one propensity score (PS) matching was performed between patients who received TXA and those who did not. Logistic regression was used to evaluate outcomes including allogenic and autologous transfusion rate, infection, deep vein thrombosis (DVT), pulmonary embolism (PE), and death. A subgroup analysis of TXA dosage (≥2000 mg vs. <2000 mg) was performed. Results: After PS matching, 134,653 patients were included in each group. TXA use significantly reduced allogeneic transfusion on post-operative Day 0 [odds ratio (OR) 0478], Day 1 (OR 0.377), and Day 2 (OR 0.339). Similarly, TXA use significantly reduced autologous transfusion rates on Day 0 (OR 0.555), Day 1 (OR 0.486), and Day 2 (OR 0.533). Higher TXA doses (≥2000 mg) further reduced Day 0 allogeneic and autologous transfusions, but increased autologous transfusion risk on Day 1. While no statistically significant differences were found in infection, PE, or death, TXA was associated with a slightly higher DVT risk. Conclusions: Peri-operative TXA use in THA reduced transfusion needs without increasing PE or mortality risks, although careful monitoring for DVT is warranted. Future studies should clarify optimal dosing strategies tailored to Japanese populations. |
| format | Article |
| id | doaj-art-e83a50bb38c64b209f38ee1ba9fe498c |
| institution | Kabale University |
| issn | 2949-7051 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Joint Surgery and Research |
| spelling | doaj-art-e83a50bb38c64b209f38ee1ba9fe498c2025-08-26T04:14:50ZengElsevierJournal of Joint Surgery and Research2949-70512025-09-013313213710.1016/j.jjoisr.2025.06.004Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complicationsHidetatsu Tanaka0Kunio Tarasawa1Yu Mori2Kazuyoshi Baba3Ryuichi Kanabuchi4Yasuaki Kuriyama5Hiroaki Kurishima6Hideki Fukuchi7Hiroki Kawamata8Kiyohide Fushimi9Toshimi Aizawa10Kenji Fujimori11Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Corresponding author. Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 43-3, 2 cho-me, Yagiyama hon-cho, Taihaku-ku, Sendai 982-8501, JapanDepartment of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 43-3, 2 cho-me, Yagiyama hon-cho, Taihaku-ku, Sendai 982-8501, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Health Policy and Informatics, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, JapanDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanDepartment of Health Administration and Policy, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, JapanPurpose: Total hip arthroplasty (THA) is an effective treatment for hip degenerative diseases; however, peri-operative blood loss often necessitates blood transfusion. Tranexamic acid (TXA) is widely used to reduce bleeding, although limited real-world evidence exists from Japanese populations. This study assessed the association between peri-operative TXA use and transfusion requirements and complications using nationwide data. Methods: THA cases in the Japanese Diagnosis Procedure Combination (DPC) database from December 2011 to March 2023 were retrospectively analyzed. Patients undergoing primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis were included. One-to-one propensity score (PS) matching was performed between patients who received TXA and those who did not. Logistic regression was used to evaluate outcomes including allogenic and autologous transfusion rate, infection, deep vein thrombosis (DVT), pulmonary embolism (PE), and death. A subgroup analysis of TXA dosage (≥2000 mg vs. <2000 mg) was performed. Results: After PS matching, 134,653 patients were included in each group. TXA use significantly reduced allogeneic transfusion on post-operative Day 0 [odds ratio (OR) 0478], Day 1 (OR 0.377), and Day 2 (OR 0.339). Similarly, TXA use significantly reduced autologous transfusion rates on Day 0 (OR 0.555), Day 1 (OR 0.486), and Day 2 (OR 0.533). Higher TXA doses (≥2000 mg) further reduced Day 0 allogeneic and autologous transfusions, but increased autologous transfusion risk on Day 1. While no statistically significant differences were found in infection, PE, or death, TXA was associated with a slightly higher DVT risk. Conclusions: Peri-operative TXA use in THA reduced transfusion needs without increasing PE or mortality risks, although careful monitoring for DVT is warranted. Future studies should clarify optimal dosing strategies tailored to Japanese populations.http://www.sciencedirect.com/science/article/pii/S2949705125000179Tranexamic acidTotal hip arthroplastyPost-operative complicationsTransfusionNationwide databaseDiagnosis procedure combination |
| spellingShingle | Hidetatsu Tanaka Kunio Tarasawa Yu Mori Kazuyoshi Baba Ryuichi Kanabuchi Yasuaki Kuriyama Hiroaki Kurishima Hideki Fukuchi Hiroki Kawamata Kiyohide Fushimi Toshimi Aizawa Kenji Fujimori Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications Journal of Joint Surgery and Research Tranexamic acid Total hip arthroplasty Post-operative complications Transfusion Nationwide database Diagnosis procedure combination |
| title | Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications |
| title_full | Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications |
| title_fullStr | Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications |
| title_full_unstemmed | Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications |
| title_short | Tranexamic acid in total hip arthroplasty: Nationwide evidence for reducing blood transfusions and post-operative complications |
| title_sort | tranexamic acid in total hip arthroplasty nationwide evidence for reducing blood transfusions and post operative complications |
| topic | Tranexamic acid Total hip arthroplasty Post-operative complications Transfusion Nationwide database Diagnosis procedure combination |
| url | http://www.sciencedirect.com/science/article/pii/S2949705125000179 |
| work_keys_str_mv | AT hidetatsutanaka tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT kuniotarasawa tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT yumori tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT kazuyoshibaba tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT ryuichikanabuchi tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT yasuakikuriyama tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT hiroakikurishima tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT hidekifukuchi tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT hirokikawamata tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT kiyohidefushimi tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT toshimiaizawa tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications AT kenjifujimori tranexamicacidintotalhiparthroplastynationwideevidenceforreducingbloodtransfusionsandpostoperativecomplications |