Safety of Tranexamic Acid: Are Precautions Needed?

There are a numerous approaches to limit blood loss in orthopedic surgery, including meticulous surgical technique and hemostasis, use of tourniquets, hypotensive anesthesia, and pharmacologic methods such as tranexamic acid (TXA). TXA is an antifibrinolytic drug that has been found to effectively treat several bleeding-related conditions. It has also been used widely among surgical subspecialties because of its effects on hemostasis and ability to reduce transfusion rates. TXA is positively transforming blood management practices with respect to orthopedic surgery. The use of TXA in orthopedic surgery remains off-label use despite the numerous studies demonstrating the benefits of TXA in orthopedic patients. However, there are concerns over potential risks associated with the use of an antifibrinolytic agent during orthopedic surgery because of the inherent risk of thromboembolic events in the perioperative period. In this article, we review the use and safety of TXA in orthopedic surgery to guide clinical practice and blood product management. Complications and evidence for the contraindications of TXA administration are also examined to provide a clear picture of the risks and benefits of using TXA in orthopedic surgery patients.