Tranexamic acid in hip replacement is linked to increased pain risk

  • Wurtz JW & al.
  • J Arthroplasty
  • 31 Jan 2020

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients undergoing primary total hip arthroplasty (THA) with topical tranexamic acid (TXA) report significantly more acute postoperative pain and consume more opioids than those having THA without TXA.

Why this matters

  • Preclinical studies had suggested a possible link between TXA and increased pain.

Study design  

  • Retrospective study of 126 consecutive THAs conducted with TXA and 134 without TXA.
  • Outcome: pain scores, narcotic use, and blood loss metrics.
  • Funding: Indiana University Health-Indiana School of Medicine Strategic Research Initiative.

Key results

  • Patients with topical TXA vs those without:
    • Had higher mean 24-hour pain scores: 3.90 vs 2.17 (P=.006).
    • Requested opioids sooner: means, 152 vs 246 minutes (P=.033).
    • Had less blood loss: 0.436 vs 0.466 L (P=.001).
    • Had higher morphine consumption during the first 24 hours after post-acute care unit discharge: 56.07 vs 31.26 mg equivalents (P<.001>
  • Pain was independently influenced by:
    • RA or PA (P<.001>
    • Preoperative scheduled narcotics (P=.005).
    • Presence of lumbar spine pain or disease (P=.027).
    • Spinal opioid (P=.033).

Limitations

  • Retrospective study design.
  • Self-reported data.

Coauthored with Vijay Rathod, PhD.