From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty
Abstract Background The use of intravenous tranexamic acid (TXA), an antifibrinolytic agent, has been shown to effectively reduce total blood loss and transfusion rates in total knee arthroplasty (TKA). The aim of this paper is to evaluate the implementation lag and clinical uptake of the use of TXA...
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BMC
2025-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05475-y |
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| author | Robin M. Pfister Benjamin F. Pfister Ronald L. Hager Nathan Sandholtz Daniel Abulafia David Bradshaw |
| author_facet | Robin M. Pfister Benjamin F. Pfister Ronald L. Hager Nathan Sandholtz Daniel Abulafia David Bradshaw |
| author_sort | Robin M. Pfister |
| collection | DOAJ |
| description | Abstract Background The use of intravenous tranexamic acid (TXA), an antifibrinolytic agent, has been shown to effectively reduce total blood loss and transfusion rates in total knee arthroplasty (TKA). The aim of this paper is to evaluate the implementation lag and clinical uptake of the use of TXA for primary TKA after publication of two landmark studies. Additionally, it assessed the efficacy of TXA use in TKA in reducing post-operative blood transfusions and hospital length of stay (LOS). Methods A total of 763 patients aged over 18 years of age underwent primary TKA at a level 4 metropolitan hospital in Australia between January 2011 and December 2017. Primary outcome measure was use of TXA at operative induction. Secondary outcome measures were post-operative blood transfusion, haemoglobin levels and in-hospital length of stay. Results The rate of TXA uptake was ≥ 50% by April–June 2013, 1.5 years following landmark paper publication. TXA use was ≥ 90% by April–June 2015, equating to 3.5 years after landmark publication. For each additional year since publication, the odds that TXA was used in a TKA surgery increased by 254.3%, 95% CI (confidence interval) [195.2%, 334.1%]. There was a negative association between TXA use and blood transfusion rate (p < 0.001), while controlling for other variables. TXA use reduced the odds of blood transfusions occurring by 73.5%, 95% CI [35.8% and 89.8%]. Analysis showed that reduced LOS was seen even after controlling for post-operative blood transfusion (p < 0.05). Conclusion The implementation lag from research to clinical practice, using ≥ 90% TXA use in TKA as a proxy, was 3.5 years. The use of TXA reduced LOS and blood transfusion rate in TKA patients. |
| format | Article |
| id | doaj-art-06d6aacb4d4b4f83ace52759c7707c48 |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-06d6aacb4d4b4f83ace52759c7707c482025-02-02T12:34:17ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-01-012011610.1186/s13018-025-05475-yFrom research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplastyRobin M. Pfister0Benjamin F. Pfister1Ronald L. Hager2Nathan Sandholtz3Daniel Abulafia4David Bradshaw5Hunter New England Health DistrictCentral Coast Local Health DistrictDepartment of Exercise Sciences, College of Life Sciences, Brigham Young UniversityDepartment of Statistics, College of Computational, Mathematical, and Physical Sciences, Brigham Young UniversityCentral Coast Local Health DistrictCentral Coast Local Health DistrictAbstract Background The use of intravenous tranexamic acid (TXA), an antifibrinolytic agent, has been shown to effectively reduce total blood loss and transfusion rates in total knee arthroplasty (TKA). The aim of this paper is to evaluate the implementation lag and clinical uptake of the use of TXA for primary TKA after publication of two landmark studies. Additionally, it assessed the efficacy of TXA use in TKA in reducing post-operative blood transfusions and hospital length of stay (LOS). Methods A total of 763 patients aged over 18 years of age underwent primary TKA at a level 4 metropolitan hospital in Australia between January 2011 and December 2017. Primary outcome measure was use of TXA at operative induction. Secondary outcome measures were post-operative blood transfusion, haemoglobin levels and in-hospital length of stay. Results The rate of TXA uptake was ≥ 50% by April–June 2013, 1.5 years following landmark paper publication. TXA use was ≥ 90% by April–June 2015, equating to 3.5 years after landmark publication. For each additional year since publication, the odds that TXA was used in a TKA surgery increased by 254.3%, 95% CI (confidence interval) [195.2%, 334.1%]. There was a negative association between TXA use and blood transfusion rate (p < 0.001), while controlling for other variables. TXA use reduced the odds of blood transfusions occurring by 73.5%, 95% CI [35.8% and 89.8%]. Analysis showed that reduced LOS was seen even after controlling for post-operative blood transfusion (p < 0.05). Conclusion The implementation lag from research to clinical practice, using ≥ 90% TXA use in TKA as a proxy, was 3.5 years. The use of TXA reduced LOS and blood transfusion rate in TKA patients.https://doi.org/10.1186/s13018-025-05475-yImplementation lagClinical uptakeTranexamic acidTotal knee arthroplastyEvidence based medicine |
| spellingShingle | Robin M. Pfister Benjamin F. Pfister Ronald L. Hager Nathan Sandholtz Daniel Abulafia David Bradshaw From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty Journal of Orthopaedic Surgery and Research Implementation lag Clinical uptake Tranexamic acid Total knee arthroplasty Evidence based medicine |
| title | From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| title_full | From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| title_fullStr | From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| title_full_unstemmed | From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| title_short | From research to practice: bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| title_sort | from research to practice bridging the implementation gap on the use of tranexamic acid in total knee arthroplasty |
| topic | Implementation lag Clinical uptake Tranexamic acid Total knee arthroplasty Evidence based medicine |
| url | https://doi.org/10.1186/s13018-025-05475-y |
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