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dc.contributor.advisorKrauss, Eugene S.en_US
dc.contributor.advisorYoung, Aaron W.en_US
dc.contributor.authorPark, Josephen_US
dc.date.accessioned2019-07-19T14:03:53Z
dc.date.available2019-07-19T14:03:53Z
dc.date.issued2019
dc.identifier.urihttps://hdl.handle.net/2144/36606
dc.description.abstractBACKGROUND: Tranexamic acid (TXA) has become highly utilized in total joint arthroplasties for its anti-fibrinolytic effect. Recently, intra-articular application of TXA has become popular for its avoidance of systemic distribution within the body. With a more direct application to the surgical site, there is interest to see if topical application will provide hemostasis without increasing rates of venous or arterial thrombotic events and infections. In particular, there is lack of published data describing the safety of TXA in patients who have a significant disposition towards thromboembolic events. METHODS: This study was a retrospective chart-review (RCR) to assess the safety and efficacy of intra-articular TXA (IA-TXA) in total knee and hip arthroplasty patients. IA-TXA 2g/50mL NS was administered to patients who were contraindicated for IV-TXA usage based on our hospital’s guidelines (history of VTE events, mitral or aortic valve replacement with additional risk factors for stroke, active cancer, genetic or acquired thrombophilia, significant cardiac disease, serum creatinine > 2.8 mg/dL). Primary efficacy outcomes were total blood loss on post-operative day 1 (POD1), overall perioperative blood loss, and changes in hemoglobin/hematocrit values over the hospital stay. Primary safety outcomes were the incidence of arterial or venous thrombosis and wound infections. The study compared patients who received IA-TXA (study group) to patients who did not receive TXA (control group). The study included TKA patients=156 (Control=72 Study=83), anterior THA patients=57 (Control=20 Study=37), and posterior THA patients=59 (Control=27 Study=32). RESULTS: TKA patients administered IA-TXA showed a significant decrease in POD1 blood loss compared to the control group [305.84 mL, p = 0.004]. Additionally, the control patients showed significantly lower levels of overall hematocrit than those who had received IA-TXA [0.9 units, p = 0.041]. However, IA-TXA did not cause a reduction in blood loss in either the anterior or posterior THA patients. No statistically significant differences existed between treatment and control groups for transfusion rates or post-operative complications (VTE events and infections). CONCLUSION: IA-TXA 2g/50mL is effective in reducing blood loss in TKA patients; however, further research is needed regarding IA-TXA use in THA patients. The lack of efficacy in THA may have been related to the dosage used, the volume instilled, the timing of administration, or technique of administration.en_US
dc.language.isoen_US
dc.rightsAttribution-NonCommercial 4.0 Internationalen_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectSurgeryen_US
dc.subjectIA-TXAen_US
dc.subjectPerioperative blood lossen_US
dc.subjectTotal hip replacementen_US
dc.subjectTotal knee replacementen_US
dc.subjectTranexamic aciden_US
dc.titleTo evaluate the safety and efficacy of intra-articular tranexamic acid in primary total joint arthoplastyen_US
dc.typeThesis/Dissertationen_US
dc.date.updated2019-06-14T16:02:24Z
etd.degree.nameMaster of Scienceen_US
etd.degree.levelmastersen_US
etd.degree.disciplineMedical Sciencesen_US
etd.degree.grantorBoston Universityen_US


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Attribution-NonCommercial 4.0 International
Except where otherwise noted, this item's license is described as Attribution-NonCommercial 4.0 International