TXA , Tranexamic Acid, Reduces Postoperative Morbidity in Foot and Ankle Surgery Patients

“TXA, tranexamic acid, is a drug that decreases bleeding. It is another breakthrough in surgery. It can be given orally, injected into the wound during surgery and used intravenously before, during and after surgery. It’s first highly successful orthopedic use is decreasing bleeding in total knee replacement. Less wound bleeding during and after surgery means a lower incidence of almost all complications in the operated leg. If you are having invasive extremity surgery, ask about it. Ask about it as about TEA, the acronym more commonly used.” Bill Chesnut, MD

Study: TXA Reduces Postoperative Morbidity in Foot and Ankle Surgery Patients

The results of a prospective randomized controlled trial—presented in Poster P206 on display in Academy Hall C—indicate that preoperative administration of 1 gram of tranexamic acid (TXA) significantly reduced blood loss, pain, and swelling in patients undergoing foot and ankle surgery. The abstract of the study, conducted by Nicholas A. Abidi, MD; Ashish Govan, BS; Clay Christensen, BS; and Jess Gifford, BS, reads as follows:

Previously published papers have demonstrated that administration of TXA prior to skin incision during hip and knee arthroplasty has resulted in significant reduction of blood loss, pain, and swelling. This prospective randomized trial sought to determine whether there were demonstrable reductions in postoperative ecchymosis, erythema, edema, pain, and incisional bleeding in patients who received TXA prior to incision for foot and ankle surgical procedures.

In this trial, 100 consecutive patients undergoing foot and ankle surgery by one surgeon were randomized into two groups: Group I and Group II. In Group I, 50 patients were administered 1 gram of TXA intravenously 20 minutes prior to skin incision. In Group II, 50 patients did not receive TXA. Demographics were obtained along with preexisting medical conditions and medications for each group. The reviewer was blinded as to the treatment groups. The reviewer was asked to rate patients’ pre- and postoperative foot and ankle images for ecchymosis, edema, erythema, and degree of fresh blood on the postoperative incision and first postoperative dressings using a scale of 0 to 3. These results were ranked and compared. Patients were also administered a Foot Function Index survey preoperatively and postoperatively at each visit.

A combination of patients undergoing forefoot, midfoot, hindfoot, and ankle surgeries qualified for the study. Data analysis showed statistically significant reductions in postoperative ecchymosis, edema, erythema, and bleeding at 2 and 6 weeks in patients who received 1 gram of TXA 20 minutes prior to skin incision, with P values of < 0.05 and F values greater than 1.0. There was one complication in the non-TXA group; one patient with excessive swelling underwent amputation of the tips of toes 2+3 after forefoot reconstruction. There were no medical complications in the TXA group. Foot function index pain scores were lower between weeks 2 and 6 postoperatively in patients who received TXA preoperatively than in patients who had not received TXA.

Preoperative administration of 1 gram of TXA significantly reduced blood loss, pain, and swelling in patients undergoing foot and ankle surgery. Patients experienced no deleterious detectible medical side effects from administration of TXA. Further studies with more patients are warranted to elaborate on these preliminary results.