Tranexamic acid was found to be safe and effective in reducing blood loss and transfusion rates in joint replacement surgery, according to findings from a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons in Orlando, FL.

Tranexamic acid is a plasminogen activation inhibitor that has been used for heart surgery, to treat hemophilia, and to stop excessive uterine bleeding. Previous studies have shown opposing data regarding the use of tranexamic acid in patients undergoing hip and knee replacements. Though the drug was shown to be safe, there was also a concern about a possibly higher risk of a blood clot .

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In the study, researchers from the Hospital for Special Surgery reviewed 4,449 patient records of those who had hip or knee replacements over a 6-month period. Of the total patients, 720 had received tranexamic acid topically, 636 had received tranexamic acid intravenously, and 3,093 had not received tranexamic acid. 

Only 9.7% of patients who received tranexamic acid got a blood transfusion, compared with 22.1% of patients who did not receive tranexamic acid; it reduced the need for a blood transfusion by over 50%. No significant difference in effect between topical or intravenous administration was seen. For patients who could not receive intravenous administration due to a contraindication, topical administration proved just as effective. 

Overall, both intravenous and topical tranexamic acid was effective in reducing the amount of blood transfusions and the number of units of blood transfused in primary and revision hip and knee replacement. Study authors added that no statistically significant difference in blood clots in patients receiving intravenous or topical tranexamic acid was seen, which reconfirms its safety. Additional studies will be needed that compare doses and combine intravenous and topical routes to determine which offers the most benefit to patients. 

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