Tranexamic Acid Shows No Associated Complications in Certain High-Risk Patients

Use of tranexamic acid is not associated with complications such as deep vein blood clots, heart attacks, seizures, or strokes or mini strokes when used in high-risk patients, according to a study published in Anesthesiology. High-risk patients are defined as those with a history of heart attacks, seizures, blood clots, strokes or mini strokes, renal disease, or irregular and rapid heart rates.

The research is intended to address a knowledge gap on the use of tranexamic acid, a drug that is currently used in the majority of patients undergoing hip and knee replacement surgery. The current study adds weight to the conclusion of smaller prior studies that show there is no evidence suggesting the drug carries more complications in high-risk patients.

“This is an important clinical conundrum that keeps coming up as we are aware of the effectiveness of tranexamic acid, but there is not that much data out there on the safety of using tranexamic acid in high-risk patients,” said Calin S. Moucha, MD, in a press release. “Our results will help anesthesiologists and surgeons in their clinical decision-making on something that is unlikely to be answered by a clinical trial.”

Using the national Premier Healthcare claims database, investigators analyzed data on patients with preexisting comorbidities who underwent hip replacement surgeries with use of tranexamic acid. The study reviewed data from over 40,000 patients at 500 United States hospitals who underwent hip and knee replacement surgeries between 2013 and 2016. According to the investigators, high-risk patients receive tranexamic acid at around the same rate as patients who are not high-risk, with no associated complications. Further, tranexamic acid use in high-risk patients undergoing hip or knee replacement surgeries is associated with fewer blood transfusions.

“This is by no means the final 'say' on this topic, but yet another encouraging sign of the safety of this drug,” said Jashvant Poeran, MD, PhD, in the press release. “With an aging population, the demand for such orthopedic surgeries is going to increase and it is, therefore, important to continue to study ways to improve patient care and outcomes.”

The investigators said future studies should focus on more detailed parameters for how to reduce the risk of complications in high-risk patients, such as comparing different ways of administering the drug—oral, intravenous, or topical—and dose adjustments.


Mount Sinai study finds that blood clotting drug commonly used for orthopedic surgeries does not increase complications for high-risk patients [news release]. EurekAlert; April 23, 2021. Accessed May 3, 2021.