Effectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study

Effectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study Laurence José Conway-Restrepo, César Alejandro Jiménez-Aroche, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8150317/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To determine the effectiveness of tranexamic acid (TXA) in reducing peri-operative blood loss quantified by postoperative hemoglobin decline and in lowering allogeneic transfusion requirements among patients undergoing primary total hip or knee arthroplasty. Methods We performed a single‑centre, retrospective cohort study, reviewing consecutive medical records of adults who underwent primary total hip or knee arthroplasty between 2015 and 2025. Patients who received TXA were compared with those who did not. Baseline characteristics, hemoglobin levels (pre‑ and post‑operative) and transfusion requirements were recorded. Changes in hemoglobin were analysed using Student’s t‑test or Mann–Whitney U, and transfusion rates were compared with the χ² or Fisher’s exact test. Results Of 184 eligible patients, 81 (44%) received TXA and 103 (56%) did not. The mean age was 64.7 ± 12.8 years; 63.9% were female and 78.5% underwent knee arthroplasty. Mean pre‑operative hemoglobin was similar in the TXA and non‑TXA groups (13.16 ± 1.31 vs. 13.13 ± 1.24 g/dL). TXA significantly reduced the average postoperative decrease in hemoglobin (1.53 ± 1.00 vs. 2.56 ± 1.25 g/dL; p < 0.001) and the need for transfusion (4.9% vs. 14.6%; RR 0.32, 95% CI 0.11–0.91; p = 0.022). No thromboembolic events attributable to TXA were observed. Conclusions Administration of TXA during hip and knee arthroplasty was associated with a significant reduction in postoperative hemoglobin decline and a 65% reduction in transfusion rate without safety concerns. Routine use of TXA enhances peri‑operative management and reduce exposure to blood products in similar settings. Level of evidence III. tranexamic acid hip arthroplasty knee arthroplasty hemoglobin transfusion retrospective cohort Figures Figure 1 Figure 2 INTRODUCTION Total hip and knee arthroplasty are increasingly common procedures for end‑stage degenerative joint disease. Blood loss during these surgeries may necessitate allogeneic transfusion, which prolongs hospital stay and increases the risk of infection and other complications [ 1 ]. International guidelines recommend tranexamic acid (TXA), an antifibrinolytic derivative of lysine, to reduce bleeding and transfusion requirements [ 2 ]. The most commonly reported side effects are nausea, vomiting, hypotension (if administered too quickly), and, in rare cases, thromboembolic events. However, recent studies have shown that its use in arthroplasty does not significantly increase the risk of thrombosis when administered properly [ 27 ] [ 28 ]. Meta‑analyses have shown that TXA reduces total blood loss by 400–500 mL per patient and decreases transfusion rates significantly [ 3 ]. A classic meta-analysis by Ho et al. reported a significant decrease in total blood loss in TCA and TRA with the use of intravenous TXA, with an average reduction of 400 to 500 mL per patient [ 2 ]. Subsequent studies have confirmed these findings in different populations, routes of administration, and dosing regimens [ 3 ][ 4 ]. Sukeik et al. compared intravenous, topical, and oral administration of TXA, finding benefits in all routes, with the intravenous route being the most studied and used in orthopedic clinical practice [ 5 ]. One of the most important clinical benefits of TXA is the reduction in the need for allogeneic transfusion. Poeran et al., in a retrospective study of more than 800,000 patients, found a significant reduction in the transfusion rate from 20.1% to 7.7% in patients undergoing total arthroplasty who received TXA [ 6 ]. Similarly, Bidolegui et al. reported that in knee arthroplasties, the use of TXA reduced the proportion of transfused patients from 32% to 0% in their prospective cohort [ 7 ]. In addition to reducing the need for transfusion, TXA has also been associated with a smaller decrease in hemoglobin levels. Fernández-Cortiñas et al. observed that patients who received TXA had a smaller mean decrease in hemoglobin compared to those who did not receive it (1.9 vs. 3.1 g/dL, p < 0.05) [ 9 ]. A meta-analysis by Alshryda et al. found that TXA reduced the drop in hemoglobin by an average of 0.85 g/dL after total knee arthroplasty [ 10 ]. However, the effectiveness of TXA in some central america countries has not been documented; thus, institutions lack evidence to inform peri‑operative protocols [ 4 ]. This study aimed to evaluate the impact of TXA on two clinically relevant outcomes—post‑operative hemoglobin decrease and transfusion rate—in patients undergoing primary hip and knee arthroplasty at a national referral hospital. METHODS This observational, retrospective cohort study was conducted in a single center. We analyzed medical records of adult patients (≥ 18 years) who underwent primary total hip (THA) or knee arthroplasty (TKA) between January 2015 and April 2025. Exclusion criteria were: incomplete records (missing pre‑ or post‑operative hemoglobin values or undocumented TXA use), missing demographic information or procedures other than primary arthroplasty. A consecutive non‑probabilistic sampling of eligible cases was performed. Of approximately 400 records identified, 184 met inclusion criteria [ 6 ]. The exposure of interest was intra‑operative administration of TXA (yes/no). Primary outcomes were: (1) postoperative hemoglobin decrease (pre‑operative hemoglobin minus first post‑operative hemoglobin) and (2) requirement for allogeneic transfusion in the immediate post‑operative period. Secondary variables included age, sex, type of arthroplasty (hip or knee), date of surgery, baseline and postoperative hemoglobin values, and relevant comorbidities (hypertension, diabetes mellitus, obesity). Variables were defined and recorded according to a standardized data‑collection form (see Appendix). ( Table 1 ) Table 1 Study Variables and Operational Definitions. Variable Type Conceptual Definition Operational Definition Possible Values TXA use Qualitative, dichotomous Administration of tranexamic acid during the surgical procedure. Recorded as “yes” if the medical chart documents TXA administration; “no” if it was not used. Yes / No Transfusion rate Qualitative, dichotomous Requirement for postoperative allogeneic blood transfusion. Recorded as “yes” if the patient received any transfusion in the immediate postoperative period; “no” otherwise. Yes / No Preoperative hemoglobin Quantitative, continuous Hemoglobin concentration prior to surgery. The most recent hemoglobin value documented before surgery (g/dL). Numeric value (g/dL) Postoperative hemoglobin Quantitative, continuous Hemoglobin concentration after surgery. The first hemoglobin value recorded postoperatively (g/dL). Numeric value (g/dL) Hemoglobin change Quantitative, continuous Difference between preoperative and postoperative hemoglobin levels. Calculated as: preoperative Hb − postoperative Hb. Numeric value Type of arthroplasty Qualitative, nominal Classification of the surgical procedure performed. Coded as “hip” or “knee” according to medical records. Hip / Knee Surgery date Qualitative, ordinal (date) Calendar date when surgery was performed, used to establish temporal sequence within the cohort. Recorded in day/month/year format. dd/mm/yyyy Age Quantitative, continuous Patient’s age in years at the time of surgery. Extracted from the medical chart as the completed years at the time of the procedure. Numeric value (years) Sex Qualitative, dichotomous Biological sex of the patient. Recorded as documented in the medical chart. Male / Female Comorbidities Qualitative, nominal (multicategorical) Pre-existing medical conditions relevant to perioperative risk. Documented presence of comorbidities such as hypertension, diabetes mellitus, obesity, or others noted in the chart. List of conditions / None Data was analysed using Epi Info 7.2®. Continuous variables were summarised as mean ± standard deviation (SD) or median and interquartile range (IQR), depending on distribution. Categorical variables were summarised as frequencies and percentages. For between‑group comparisons, Student’s t‑test (or Mann–Whitney U when normality was rejected) was used for continuous variables, and χ² or Fisher’s exact test for categorical variables. Risk ratio (RR) with 95% CI was calculated for the effect of TXA on transfusion requirement. Statistical significance was set at p < 0.05 [ 7 ]. RESULTS A total of 184 patients were included: 81 received TXA and 103 did not. The overall mean age was 64.7 ± 12.8 years (range 42–87 years). The sample comprised 119 women (63.9%) and 67 men (36.1%). Most procedures were knee arthroplasties (146 procedures, 78.5%) and the remainder were hip arthroplasties (38, 20.4%). (Table 2 ) Baseline hemoglobin was similar between TXA and non‑TXA groups (13.16 ± 1.31 vs 13.13 ± 1.24 g/dL) [ 8 ]. Table 2 Baseline Characteristics of the Study Population Variable Mean ± SD / n (%) Range Age (years) 64.7 ± 12.8 42–87 Female sex 119 (63.9%) — Male sex 67 (36.1%) — Knee arthroplasty 146 (78.5%) — Hip arthroplasty 38 (20.4%) — Post‑operative hemoglobin decline Patients receiving TXA had a mean post‑operative hemoglobin of 11.63 ± 1.41 g/dL, compared with 10.57 ± 1.63 g/dL in those who did not receive TXA. The mean hemoglobin decrease was 1.53 ± 1.00 g/dL vs 2.56 ± 1.25 g/dL, respectively, a statistically significant difference (p < 0.001, Welch’s t‑test) [ 9 ]. ( Table 3 ) ( Fig. 1 ) Table 3 Bivariate Analysis of Hemoglobin Drop According to TXA Use. Group Pre-op Hb (g/dL), Mean ± SD (95% CI) Post-op Hb (g/dL), Mean ± SD (95% CI) ΔHb, Mean ± SD (95% CI) p-value TXA group (n = 81) 13.16 ± 1.31 (12.87–13.45) 11.63 ± 1.41 (11.32–11.94) 1.53 ± 1.00 (1.31–1.75) No-TXA group (n = 103) 13.13 ± 1.24 (12.89–13.37) 10.57 ± 1.63 (10.25–10.89) 2.56 ± 1.25 (2.31–2.81) < 0.001 * Transfusion requirement Only 4 of 81 patients (4.9%) in the TXA group required a transfusion compared with 15 of 103 patients (14.6%) in the non‑TXA group. TXA administration was associated with a risk ratio of 0.32 (95% CI 0.11–0.91; p = 0.022), indicating a 68% relative reduction in transfusion requirement [ 10 ]. ( Table 4 ) ( Fig. 2 ) Table 4 Transfusion Rates According to TXA Use. Group Required transfusion, n No transfusion, n Total Transfusion rate (%) OR (95% CI) p-value TXA group (n = 81) 4 77 81 4.9% — No-TXA group (n = 103) 15 88 103 14.6% 0.32 (0.11–0.91) 0.022 * No thromboembolic or cardiovascular events attributable to TXA were documented. DISCUSSION This retrospective cohort shows that intra‑operative TXA use in primary hip and knee arthroplasty significantly decreases postoperative hemoglobin loss and transfusion requirements. The reduction in hemoglobin decline (mean difference ≈ 1 g/dL) is similar to meta‑analytic estimates [ 12 ] and supports the haemostatic efficacy of TXA. The decrease in hemoglobin observed in the group without TXA (2.56 g/dL) is comparable to historical values in patients without antifibrinolytics, while the reduction in the group with TXA (1.53 g/dL). This difference is consistent with the antifibrinolytic mechanism of TXA and reflects the reductions described in contemporary high-level studies and meta-analyses. It coincides with Fernández-Cortiñas et al., who reported a decrease of 1.9 vs. 3.1 g/dL in patients with and without TXA in hip arthroplasty [ 10 ] and the meta‑analysis by Alshryda et al., which showed an average reduction of 0.85 g/dL in knee arthroplasty [ 11 ]. Also, meta‑analytic work by Fillingham and colleagues has shown that TXA reduces peri‑operative hemoglobin by around 1.0–1.5 g/dL across various routes of administration [ 27 ]. The observed transfusion rate in the non‑TXA group (14.6%) mirrors historical reports without antifibrinolytic therapy, whereas the 4.9% transfusion rate in the TXA group is consistent with reductions reported in large retrospective analyses [ 13 ]. In our cohort patients not treated with TXA were nearly three times more likely to require allogeneic transfusions (p = 0.022), these results align with robust evidence demonstrating up to an 80% reduction in transfusion risk, including the Poeran et al. multicentre trial. More recent analyses have similarly confirmed reductions in transfusion requirements irrespective of surgical approach, implant or anaesthetic modality [ 29 ]. Importantly, no thromboembolic complications were identified, corroborating the safety profile reported in systematic reviews [ 14 ]. These findings are consistent with the study by Poeran et al., and with the prospective trial by Bidolegui et al., which reduced the need for transfusions from 32% to 0% in knee arthroplasty [ 9 ]. Importantly, both main findings are clinically significant, not merely statistical. A smaller postoperative hemoglobin decline minimizes symptomatic anemia, reducing the likelihood of transfusion, and may contribute to faster mobilization and improved early recovery. Our results also underscore the consistency of TXA effect across both hip and knee arthroplasty, within the same institutional setting. The benefit was observed without evidence of diminished effect size in either subgroup, supporting the use of TXA as a standard component of perioperative protocol regardless of the joint involved. Overall, the results of this study reinforce the strong evidence base supporting TXA as an effective and safe agent for reducing blood loss and transfusion requirements in primary arthroplasty. The substantial reductions in hemoglobin decline and transfusion probabilities observed in our cohort reinforce current recommendations advocating the routine use of TXA, provided there are no specific contraindications for each patient. Importantly, no thromboembolic or cardiovascular events attributable to TXA were observed in our cohort. This is consistent with systematic reviews such as that by Fillingham et al., which confirmed the safety of TXA in patients even with risk factors for venous thromboembolism [ 27 ]. For many institutions in Central America, incorporating TXA into peri‑operative protocols for arthroplasty could meaningfully reduce blood loss and transfusion exposure, thereby improving patient outcomes and conserving healthcare resources. The findings support recommendations from the American Academy of Orthopaedic Surgeons and the National Institute for Health and Care Excellence, which endorse TXA as part of standard care provided there are no specific contraindications. Including TXA systematically in the surgical checklist could optimise recovery, reduce postoperative anaemia, shorten hospital stay and decrease healthcare costs, especially in public institutions with limited blood‑bank resources. In countries such as Panama and other Central American regions—where transfusion protocols are frequently heterogeneous and access to blood products is limited—TXA may represent a key strategy for improving peri‑operative outcomes and strengthening evidence‑based arthroplasty protocols. Future regional studies are needed to determine optimal dosing, timing and route of administration adapted to Latin American surgical populations. Despite our strengths, our findings require acknowledging inherent limitations. First, although hemoglobin drop is a standars surrogate for blood loss, it is influenced by fluid shifts and timing of postoperative labs, potentially biasing comparisons between groups. Second, the triggers for transfusion in retrospective cohorts may vary subtly between surgeons or between calendar years, introducing variability in practice patterns. Third, our study does not distinguish between intravenous, topical or combined TXA protocols; several meta‑analyses have suggested that while all modalities are effective, combined regimens may have synergistic effects that were not accounted for here [ 27 ],[ 28 ]. This study also has limitations inherent to retrospective designs: potential selection bias, reliance on existing records and absence of randomisation. The long inclusion period (2015–2025) may introduce temporal variations in surgical technique or peri‑operative management [ 17 ]. Although the sample size exceeds the estimated minimum, residual confounding may persist despite statistical adjustments. Future prospective or multicentre studies could confirm these findings and explore optimal dosing strategies. CONCLUSIONS Intra‑operative administration of tranexamic acid during primary hip and knee arthroplasty significantly reduced postoperative hemoglobin decline and the need for transfusion without detectable safety issues. These results support the routine use of TXA in arthroplasty protocols and provide local evidence for implementing national guidelines. Declarations Ethics Approval This study was reviewed and approved by the Comité de Bioética en Investigación del Hospital del Niño Doctor José Renán Esquivel (Panamá). Approval reference number: CBIHN-M-202507-0007. Ethics approval was granted on June 10, 2025, and no waiver was requested. All data were anonymized prior to analysis, in compliance with national regulations. Consent for publication Not applicable. The study does not contain identifiable personal data from any individual. Competing interests The authors declare that they have no competing interests related to this study. Authors' information C.A. Jiménez-Aroche is a senior resident in Orthopedic Surgery, with a Masters Degree with a clinical and research focus on lower-limb surgery, arthroplasty and peri-operative optimization. His academic works includes outcomes research in joint reconstruction and comparative effectiveness studies in sports and arthroplasty surgery. Funding This research received no external funding. Author Contribution - **C.A. Jiménez-Aroche (C.A.J.)** : Conceptualization; study design; data curation; statistical analysis; interpretation of results; drafting of the manuscript; creation of figures and tables; final approval of the manuscript.- **L.J. Conway-Restrepo (L.J.C.R.)** : Data collection; verification of clinical records; methodology support; critical revision of the manuscript.- **R. Pinilla (R.P.)** : Interpretation of peri-operative clinical data; supervision; critical revision of the manuscript for important intellectual content.- **R. Pérez (R.Pz.)** : Surgical oversight; validation of clinical endpoints; review and editing of the final manuscript.All authors read and approved the final manuscript. Acknowledgements The authors thank the surgical staff, nursing personnel, and medical records department for their support in facilitating access to peri-operative data. Special acknowledgement is extended to the reconstruction unit for maintaining standardized clinical documentation that made this study possible. Data Availability The dataset supporting the conclusions of this article is available from the corresponding author, C.A. Jiménez-Aroche, upon reasonable request. 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14:25:02","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86738,"visible":true,"origin":"","legend":"","description":"","filename":"537e6e2458a04507a2d55e14a4a8f60d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/0a1bf66593fd31687002f340.xml"},{"id":97990049,"identity":"d0629a71-175c-46b2-b0fe-867bbe328352","added_by":"auto","created_at":"2025-12-11 14:24:55","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":13797,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/9677a4cf5ba931dacca71454.png"},{"id":97990064,"identity":"03d59fd9-f27a-4b0c-8fd7-3d0fe6c77d04","added_by":"auto","created_at":"2025-12-11 14:25:03","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11508,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/55f2f3c2342bfff0af1e5022.png"},{"id":97990047,"identity":"ef12c3b3-e4d4-45bb-98de-46fba5a25512","added_by":"auto","created_at":"2025-12-11 14:24:55","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80335,"visible":true,"origin":"","legend":"","description":"","filename":"537e6e2458a04507a2d55e14a4a8f60d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/91f50d42cab6021b89f2566a.xml"},{"id":98424958,"identity":"e6f3fd8f-f065-4d7c-86b9-39887f7ad351","added_by":"auto","created_at":"2025-12-17 16:34:07","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91670,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/779c61ad1deaa63101259e8a.html"},{"id":97990054,"identity":"35e4d551-182b-4212-968e-55846f41b67c","added_by":"auto","created_at":"2025-12-11 14:25:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58537,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative hemoglobin levels in patients who received tranexamic acid (TXA) compared with those who did not. The TXA group demonstrated a smaller postoperative decline in hemoglobin, consistent with reduced perioperative blood loss.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/3c66231474b3921310ccc33d.png"},{"id":97990058,"identity":"f31bdbc9-744d-4cb9-8c99-91ba2cc7f4b7","added_by":"auto","created_at":"2025-12-11 14:25:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46369,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative transfusion rates in patients who received tranexamic acid (TXA) compared with those who did not. The TXA group exhibited a substantially lower transfusion requirement (4.9%) relative to the No-TXA group (14.6%).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/68fef850c3254c5dfbe0f5a4.png"},{"id":98776310,"identity":"54aa0ea7-3f0c-48f5-840c-65d7e0fc5528","added_by":"auto","created_at":"2025-12-22 12:22:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":761448,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8150317/v1/ce49dd88-212c-4b2f-bf46-90a454b4395c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTotal hip and knee arthroplasty are increasingly common procedures for end‑stage degenerative joint disease. Blood loss during these surgeries may necessitate allogeneic transfusion, which prolongs hospital stay and increases the risk of infection and other complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. International guidelines recommend tranexamic acid (TXA), an antifibrinolytic derivative of lysine, to reduce bleeding and transfusion requirements [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The most commonly reported side effects are nausea, vomiting, hypotension (if administered too quickly), and, in rare cases, thromboembolic events. However, recent studies have shown that its use in arthroplasty does not significantly increase the risk of thrombosis when administered properly [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Meta‑analyses have shown that TXA reduces total blood loss by 400\u0026ndash;500 mL per patient and decreases transfusion rates significantly [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA classic meta-analysis by Ho et al. reported a significant decrease in total blood loss in TCA and TRA with the use of intravenous TXA, with an average reduction of 400 to 500 mL per patient [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Subsequent studies have confirmed these findings in different populations, routes of administration, and dosing regimens [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Sukeik et al. compared intravenous, topical, and oral administration of TXA, finding benefits in all routes, with the intravenous route being the most studied and used in orthopedic clinical practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the most important clinical benefits of TXA is the reduction in the need for allogeneic transfusion. Poeran et al., in a retrospective study of more than 800,000 patients, found a significant reduction in the transfusion rate from 20.1% to 7.7% in patients undergoing total arthroplasty who received TXA [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, Bidolegui et al. reported that in knee arthroplasties, the use of TXA reduced the proportion of transfused patients from 32% to 0% in their prospective cohort [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition to reducing the need for transfusion, TXA has also been associated with a smaller decrease in hemoglobin levels. Fern\u0026aacute;ndez-Corti\u0026ntilde;as et al. observed that patients who received TXA had a smaller mean decrease in hemoglobin compared to those who did not receive it (1.9 vs. 3.1 g/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A meta-analysis by Alshryda et al. found that TXA reduced the drop in hemoglobin by an average of 0.85 g/dL after total knee arthroplasty [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the effectiveness of TXA in some central america countries has not been documented; thus, institutions lack evidence to inform peri‑operative protocols [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This study aimed to evaluate the impact of TXA on two clinically relevant outcomes\u0026mdash;post‑operative hemoglobin decrease and transfusion rate\u0026mdash;in patients undergoing primary hip and knee arthroplasty at a national referral hospital.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis observational, retrospective cohort study was conducted in a single center. We analyzed medical records of adult patients (\u0026ge;\u0026thinsp;18 years) who underwent primary total hip (THA) or knee arthroplasty (TKA) between January 2015 and April 2025. Exclusion criteria were: incomplete records (missing pre‑ or post‑operative hemoglobin values or undocumented TXA use), missing demographic information or procedures other than primary arthroplasty. A consecutive non‑probabilistic sampling of eligible cases was performed. Of approximately 400 records identified, 184 met inclusion criteria [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe exposure of interest was intra‑operative administration of TXA (yes/no). Primary outcomes were: (1) postoperative hemoglobin decrease (pre‑operative hemoglobin minus first post‑operative hemoglobin) and (2) requirement for allogeneic transfusion in the immediate post‑operative period. Secondary variables included age, sex, type of arthroplasty (hip or knee), date of surgery, baseline and postoperative hemoglobin values, and relevant comorbidities (hypertension, diabetes mellitus, obesity). Variables were defined and recorded according to a standardized data‑collection form (see Appendix). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy Variables and Operational Definitions.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConceptual Definition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOperational Definition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePossible Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTXA use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, dichotomous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdministration of tranexamic acid during the surgical procedure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRecorded as \u0026ldquo;yes\u0026rdquo; if the medical chart documents TXA administration; \u0026ldquo;no\u0026rdquo; if it was not used.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes / No\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransfusion rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, dichotomous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRequirement for postoperative allogeneic blood transfusion.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRecorded as \u0026ldquo;yes\u0026rdquo; if the patient received any transfusion in the immediate postoperative period; \u0026ldquo;no\u0026rdquo; otherwise.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes / No\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative hemoglobin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantitative, continuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHemoglobin concentration prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe most recent hemoglobin value documented before surgery (g/dL).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumeric value (g/dL)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative hemoglobin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantitative, continuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHemoglobin concentration after surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe first hemoglobin value recorded postoperatively (g/dL).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumeric value (g/dL)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantitative, continuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDifference between preoperative and postoperative hemoglobin levels.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCalculated as: preoperative Hb\u0026thinsp;\u0026minus;\u0026thinsp;postoperative Hb.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumeric value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, nominal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClassification of the surgical procedure performed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCoded as \u0026ldquo;hip\u0026rdquo; or \u0026ldquo;knee\u0026rdquo; according to medical records.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHip / Knee\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery date\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, ordinal (date)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCalendar date when surgery was performed, used to establish temporal sequence within the cohort.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRecorded in day/month/year format.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003edd/mm/yyyy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantitative, continuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient\u0026rsquo;s age in years at the time of surgery.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExtracted from the medical chart as the completed years at the time of the procedure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumeric value (years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, dichotomous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBiological sex of the patient.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRecorded as documented in the medical chart.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale / Female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQualitative, nominal (multicategorical)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-existing medical conditions relevant to perioperative risk.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDocumented presence of comorbidities such as hypertension, diabetes mellitus, obesity, or others noted in the chart.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eList of conditions / None\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData was analysed using Epi Info 7.2\u0026reg;. Continuous variables were summarised as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median and interquartile range (IQR), depending on distribution. Categorical variables were summarised as frequencies and percentages. For between‑group comparisons, Student\u0026rsquo;s t‑test (or Mann\u0026ndash;Whitney U when normality was rejected) was used for continuous variables, and χ\u0026sup2; or Fisher\u0026rsquo;s exact test for categorical variables. Risk ratio (RR) with 95% CI was calculated for the effect of TXA on transfusion requirement. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 184 patients were included: 81 received TXA and 103 did not. The overall mean age was 64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8 years (range 42\u0026ndash;87 years). The sample comprised 119 women (63.9%) and 67 men (36.1%). Most procedures were knee arthroplasties (146 procedures, 78.5%) and the remainder were hip arthroplasties (38, 20.4%). (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) Baseline hemoglobin was similar between TXA and non‑TXA groups (13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 vs 13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24 g/dL) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of the Study Population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u0026ndash;87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (63.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (36.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnee arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e146 (78.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHip arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (20.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003ePost‑operative hemoglobin decline\u003c/h3\u003e\n\u003cp\u003ePatients receiving TXA had a mean post‑operative hemoglobin of 11.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 g/dL, compared with 10.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63 g/dL in those who did not receive TXA. The mean hemoglobin decrease was 1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 g/dL vs 2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 g/dL, respectively, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Welch\u0026rsquo;s t‑test) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate Analysis of Hemoglobin Drop According to TXA Use.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-op Hb (g/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-op Hb (g/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eΔHb, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTXA group (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 (12.87\u0026ndash;13.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 (11.32\u0026ndash;11.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 (1.31\u0026ndash;1.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo-TXA group (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24 (12.89\u0026ndash;13.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e10.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63 (10.25\u0026ndash;10.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 (2.31\u0026ndash;2.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eTransfusion requirement\u003c/h3\u003e\n\u003cp\u003eOnly 4 of 81 patients (4.9%) in the TXA group required a transfusion compared with 15 of 103 patients (14.6%) in the non‑TXA group. TXA administration was associated with a risk ratio of 0.32 (95% CI 0.11\u0026ndash;0.91; p\u0026thinsp;=\u0026thinsp;0.022), indicating a 68% relative reduction in transfusion requirement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTransfusion Rates According to TXA Use.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRequired transfusion, n\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo transfusion, n\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTransfusion rate (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTXA group (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo-TXA group (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.32 (0.11\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNo thromboembolic or cardiovascular events attributable to TXA were documented.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis retrospective cohort shows that intra‑operative TXA use in primary hip and knee arthroplasty significantly decreases postoperative hemoglobin loss and transfusion requirements. The reduction in hemoglobin decline (mean difference\u0026thinsp;\u0026asymp;\u0026thinsp;1 g/dL) is similar to meta‑analytic estimates [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and supports the haemostatic efficacy of TXA.\u003c/p\u003e\u003cp\u003eThe decrease in hemoglobin observed in the group without TXA (2.56 g/dL) is comparable to historical values in patients without antifibrinolytics, while the reduction in the group with TXA (1.53 g/dL). This difference is consistent with the antifibrinolytic mechanism of TXA and reflects the reductions described in contemporary high-level studies and meta-analyses. It coincides with Fern\u0026aacute;ndez-Corti\u0026ntilde;as et al., who reported a decrease of 1.9 vs. 3.1 g/dL in patients with and without TXA in hip arthroplasty [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the meta‑analysis by Alshryda et al., which showed an average reduction of 0.85 g/dL in knee arthroplasty [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Also, meta‑analytic work by Fillingham and colleagues has shown that TXA reduces peri‑operative hemoglobin by around 1.0\u0026ndash;1.5 g/dL across various routes of administration [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe observed transfusion rate in the non‑TXA group (14.6%) mirrors historical reports without antifibrinolytic therapy, whereas the 4.9% transfusion rate in the TXA group is consistent with reductions reported in large retrospective analyses [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our cohort patients not treated with TXA were nearly three times more likely to require allogeneic transfusions (p\u0026thinsp;=\u0026thinsp;0.022), these results align with robust evidence demonstrating up to an 80% reduction in transfusion risk, including the Poeran et al. multicentre trial. More recent analyses have similarly confirmed reductions in transfusion requirements irrespective of surgical approach, implant or anaesthetic modality [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImportantly, no thromboembolic complications were identified, corroborating the safety profile reported in systematic reviews [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings are consistent with the study by Poeran et al., and with the prospective trial by Bidolegui et al., which reduced the need for transfusions from 32% to 0% in knee arthroplasty [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImportantly, both main findings are clinically significant, not merely statistical. A smaller postoperative hemoglobin decline minimizes symptomatic anemia, reducing the likelihood of transfusion, and may contribute to faster mobilization and improved early recovery. Our results also underscore the consistency of TXA effect across both hip and knee arthroplasty, within the same institutional setting.\u003c/p\u003e\u003cp\u003eThe benefit was observed without evidence of diminished effect size in either subgroup, supporting the use of TXA as a standard component of perioperative protocol regardless of the joint involved. Overall, the results of this study reinforce the strong evidence base supporting TXA as an effective and safe agent for reducing blood loss and transfusion requirements in primary arthroplasty. The substantial reductions in hemoglobin decline and transfusion probabilities observed in our cohort reinforce current recommendations advocating the routine use of TXA, provided there are no specific contraindications for each patient.\u003c/p\u003e\u003cp\u003eImportantly, no thromboembolic or cardiovascular events attributable to TXA were observed in our cohort. This is consistent with systematic reviews such as that by Fillingham et al., which confirmed the safety of TXA in patients even with risk factors for venous thromboembolism [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor many institutions in Central America, incorporating TXA into peri‑operative protocols for arthroplasty could meaningfully reduce blood loss and transfusion exposure, thereby improving patient outcomes and conserving healthcare resources. The findings support recommendations from the American Academy of Orthopaedic Surgeons and the National Institute for Health and Care Excellence, which endorse TXA as part of standard care provided there are no specific contraindications.\u003c/p\u003e\u003cp\u003eIncluding TXA systematically in the surgical checklist could optimise recovery, reduce postoperative anaemia, shorten hospital stay and decrease healthcare costs, especially in public institutions with limited blood‑bank resources. In countries such as Panama and other Central American regions\u0026mdash;where transfusion protocols are frequently heterogeneous and access to blood products is limited\u0026mdash;TXA may represent a key strategy for improving peri‑operative outcomes and strengthening evidence‑based arthroplasty protocols. Future regional studies are needed to determine optimal dosing, timing and route of administration adapted to Latin American surgical populations.\u003c/p\u003e\u003cp\u003eDespite our strengths, our findings require acknowledging inherent limitations. First, although hemoglobin drop is a standars surrogate for blood loss, it is influenced by fluid shifts and timing of postoperative labs, potentially biasing comparisons between groups. Second, the triggers for transfusion in retrospective cohorts may vary subtly between surgeons or between calendar years, introducing variability in practice patterns. Third, our study does not distinguish between intravenous, topical or combined TXA protocols; several meta‑analyses have suggested that while all modalities are effective, combined regimens may have synergistic effects that were not accounted for here [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e],[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study also has limitations inherent to retrospective designs: potential selection bias, reliance on existing records and absence of randomisation. The long inclusion period (2015\u0026ndash;2025) may introduce temporal variations in surgical technique or peri‑operative management [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the sample size exceeds the estimated minimum, residual confounding may persist despite statistical adjustments. Future prospective or multicentre studies could confirm these findings and explore optimal dosing strategies.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIntra‑operative administration of tranexamic acid during primary hip and knee arthroplasty significantly reduced postoperative hemoglobin decline and the need for transfusion without detectable safety issues. These results support the routine use of TXA in arthroplasty protocols and provide local evidence for implementing national guidelines.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003cp\u003e This study was reviewed and approved by the Comit\u0026eacute; de Bio\u0026eacute;tica en Investigaci\u0026oacute;n del Hospital del Ni\u0026ntilde;o Doctor Jos\u0026eacute; Ren\u0026aacute;n Esquivel (Panam\u0026aacute;). Approval reference number: \u003cb\u003eCBIHN-M-202507-0007.\u003c/b\u003e Ethics approval was granted on June 10, 2025, and no waiver was requested. All data were anonymized prior to analysis, in compliance with national regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable. The study does not contain identifiable personal data from any individual.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests related to this study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eAuthors' information\u003c/h2\u003e\u003cp\u003eC.A. Jim\u0026eacute;nez-Aroche is a senior resident in Orthopedic Surgery, with a Masters Degree with a clinical and research focus on lower-limb surgery, arthroplasty and peri-operative optimization. His academic works includes outcomes research in joint reconstruction and comparative effectiveness studies in sports and arthroplasty surgery.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e- **C.A. Jim\u0026eacute;nez-Aroche (C.A.J.)** : Conceptualization; study design; data curation; statistical analysis; interpretation of results; drafting of the manuscript; creation of figures and tables; final approval of the manuscript.- **L.J. Conway-Restrepo (L.J.C.R.)** : Data collection; verification of clinical records; methodology support; critical revision of the manuscript.- **R. Pinilla (R.P.)** : Interpretation of peri-operative clinical data; supervision; critical revision of the manuscript for important intellectual content.- **R. P\u0026eacute;rez (R.Pz.)** : Surgical oversight; validation of clinical endpoints; review and editing of the final manuscript.All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors thank the surgical staff, nursing personnel, and medical records department for their support in facilitating access to peri-operative data. Special acknowledgement is extended to the reconstruction unit for maintaining standardized clinical documentation that made this study possible.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset supporting the conclusions of this article is available from the corresponding author, C.A. Jim\u0026eacute;nez-Aroche, upon reasonable request. De-identified data may be shared in accordance with institutional policies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePoeran J, Rasul R, Suzuki S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ. 2014;349:g4829.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic acid in total joint arthroplasty: the clinical practice guidelines of the AAOS. J Arthroplasty. 2018;33(10):3065\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenry DA, Carless PA, Moxey AJ, et al. Anti\u0026ndash;fibrinolytic use for minimising peri\u0026ndash;operative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;1:CD001886.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHo KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta\u0026ndash;analysis. Anaesth Intensive Care. 2003;31(5):529\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou XD, Tao LJ, Li J, Wu LD. Do we really need tranexamic acid in total hip arthroplasty? A meta\u0026ndash;analysis of nineteen randomized controlled trials. Int Orthop. 2013;37(10):2101\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Academy of Orthopaedic Surgeons. Clinical practice guideline on tranexamic acid in total joint arthroplasty. Rosemont, IL: AAOS; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Institute for Health and Care Excellence. Tranexamic acid for reducing blood loss in orthopaedic surgery. Technology appraisal guidance; 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArias\u0026ndash;Rodr\u0026iacute;guez WE, Lizcano\u0026ndash;Ortiz VH, Morales\u0026ndash;Guerrero OJ, et al. Efecto en la transfusi\u0026oacute;n posoperatoria de pacientes con artroplastia de rodilla mediante dosis \u0026uacute;nica de \u0026aacute;cido tranex\u0026aacute;mico preoperatorio. Rev Col Or Tra. 2020;34(2):151\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBidolegui F, Pereira S, Lugones A, Zamboni W. Uso de \u0026aacute;cido tranex\u0026aacute;mico en cirug\u0026iacute;a ortop\u0026eacute;dica: resultados de un ensayo aleatorizado en artroplastia total de rodilla. Rev Argent Ortop Traumatol. 2019;84(2):128\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez\u0026ndash;Corti\u0026ntilde;as AB, Quint\u0026aacute;ns\u0026ndash;V\u0026aacute;zquez JM, G\u0026oacute;mez\u0026ndash;Su\u0026aacute;rez F, et al. Eficacia del \u0026aacute;cido tranex\u0026aacute;mico en artroplastia total de cadera. Rev Esp Cir Ortop Traumatol. 2017;61(5):289\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlshryda S, Sarda P, Sukeik M, et al. Tranexamic acid in total knee replacement: a systematic review and meta\u0026ndash;analysis. Bone Joint J. 2013;95\u0026ndash;B(11):1320\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSukeik M, Alshryda S, Haddad FS. Systematic review and meta\u0026ndash;analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011;93(11):1449\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD\u0026rsquo;Souza R, Duncan C, Whiting D, et al. Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty. Biomolecules Biomed. 2021;21(4):471\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaalouly J, El Assaad D, Ayoubi R, Tawk A, Darwish M, Aouad D, et al. Efficacy and safety of systemic tranexamic acid administration in total knee arthroplasty: a case series. Int J Surg Case Rep. 2020;73:90\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJovanović G, Lukić\u0026ndash;Sarkanović M, Lazetić F, Tubić T, Lendak D, Uvelin A. The effect of intravenous tranexamic acid on perioperative blood loss, transfusion requirements, verticalization and ambulation in total knee arthroplasty: a randomized double\u0026ndash;blind study. Med (Kaunas). 2024;60(7):1183.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThapaliya A, Mittal MM, Ratcliff TL, Mounasamy V, Wukich DK, Sambandam SN. Usage of tranexamic acid for total hip arthroplasty: a matched cohort analysis of 144,344 patients. J Clin Med. 2022;13(16):4920.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArias\u0026ndash;Rodr\u0026iacute;guez WE, Lizcano\u0026ndash;Ortiz VH, Morales\u0026ndash;Guerrero OJ, Bol\u0026iacute;var LE, Alba\u0026ndash;Huertas AK, Cubillos\u0026ndash;Rojas J. Efecto en la transfusi\u0026oacute;n posoperatoria de pacientes con artroplastia de rodilla mediante dosis \u0026uacute;nica de \u0026aacute;cido tranex\u0026aacute;mico preoperatorio. Rev Colomb Ortop Traumatol. 2020;34(2):151\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCam N, Balkanlı B, Altuntaş Y, Kanar M, \u0026Ouml;zdemir HM. The effect of local tranexamic acid administration on blood loss and transfusion in total knee arthroplasty: a retrospective study. Med Bull Sisli Etfal Hosp. 2023;57(2):245\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDang X, Liu M, Yang Q, Jiang J, Liu Y. Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta\u0026ndash;analysis. EFORT Open Rev. 2024;9(6):467\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhamed HN, Mohan S, Krishnan R, Jeevannavar C, Ullah E, Naveen S, et al. Role of tranexamic acid in controlling blood loss in hemiarthroplasty of the hip: a prospective observational study. Cureus. 2024;16(6):e62617.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCho MR, Jun CM, Song SK, Choi WK. Natural course of hemoglobin level after total knee arthroplasty and the benefit of tranexamic acid injection in the joint. Med (Baltim). 2021;100(35):e27097.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZha GC, Zhu XR, Wang L, Li HW. Tranexamic acid reduces blood loss in primary total hip arthroplasty via the direct anterior approach: a one\u0026ndash;centre retrospective study. J Orthop Traumatol. 2022;23(1):12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKonarski W, Poboży T, Hordowicz M. Tranexamic acid in total knee and hip arthroplasty \u0026ndash; a single\u0026ndash;centre retrospective study. Orthop Rev (Pavia). 2022;14(2):e33875.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKang PD, Hu W, Zhang Y, Cheng X, Gao X, Cheng C, et al. Efficacy of different doses of intra\u0026ndash;articular tranexamic acid for reducing blood loss and lower limb swelling after total knee arthroplasty: a prospective randomised controlled trial. Orthop Surg. 2024;16(3):693\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Schaik D, L\u0026ouml;wik CAM, Mathijssen NMC, van den Hout JHCM, van den Bekerom MPJ, Nelissen RGHH. Complications after total hip and knee arthroplasty in the Netherlands: 5\u0026ndash;year incidence and risk factors in the LROI. Acta Orthop. 2021;92(5):503\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Enhanced recovery after surgery (ERAS) and its applicability for major joint replacement: a consensus statement from the ERAS Society. Acta Orthop. 2020;91(1):3\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, et al. The efficacy of tranexamic acid in total knee arthroplasty: a network meta\u0026ndash;analysis. J Arthroplasty. 2020;35(10):2739\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKonan S, Burn E, Haddad FS. Safety and efficacy of tranexamic acid in arthroplasty: a single\u0026ndash;centre analysis of 1,178 procedures. Bone Joint J. 2021;103\u0026ndash;B(2):289\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoeran J, Rasul R, Suzuki S, Della Valle CJ, Memtsoudis SG. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ. 2022;376:e065476.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArias\u0026ndash;Rodr\u0026iacute;guez WE, Bonilla\u0026ndash;Guti\u0026eacute;rrez J, Garc\u0026iacute;a J, \u0026Aacute;lvarez E. Evaluaci\u0026oacute;n del uso de \u0026aacute;cido tranex\u0026aacute;mico en artroplastia total de rodilla. Rev Colomb Ortop Traumatol. 2020;34(1):11\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBidolegui F, Pereira S, Lugones A, Zamboni W. Topical vs. intravenous tranexamic acid in primary total knee arthroplasty: a prospective randomised controlled trial. J Orthop. 2020;21:30\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"tranexamic acid, hip arthroplasty, knee arthroplasty, hemoglobin, transfusion, retrospective cohort","lastPublishedDoi":"10.21203/rs.3.rs-8150317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8150317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo determine the effectiveness of tranexamic acid (TXA) in reducing peri-operative blood loss quantified by postoperative hemoglobin decline and in lowering allogeneic transfusion requirements among patients undergoing primary total hip or knee arthroplasty.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e We performed a single‑centre, retrospective cohort study, reviewing consecutive medical records of adults who underwent primary total hip or knee arthroplasty between 2015 and 2025. Patients who received TXA were compared with those who did not. Baseline characteristics, hemoglobin levels (pre‑ and post‑operative) and transfusion requirements were recorded. Changes in hemoglobin were analysed using Student\u0026rsquo;s t‑test or Mann\u0026ndash;Whitney U, and transfusion rates were compared with the χ\u0026sup2; or Fisher\u0026rsquo;s exact test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 184 eligible patients, 81 (44%) received TXA and 103 (56%) did not. The mean age was 64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8 years; 63.9% were female and 78.5% underwent knee arthroplasty. Mean pre‑operative hemoglobin was similar in the TXA and non‑TXA groups (13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 vs. 13.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24 g/dL). TXA significantly reduced the average postoperative decrease in hemoglobin (1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00 vs. 2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 g/dL; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the need for transfusion (4.9% vs. 14.6%; RR 0.32, 95% CI 0.11\u0026ndash;0.91; p\u0026thinsp;=\u0026thinsp;0.022). No thromboembolic events attributable to TXA were observed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAdministration of TXA during hip and knee arthroplasty was associated with a significant reduction in postoperative hemoglobin decline and a 65% reduction in transfusion rate without safety concerns. Routine use of TXA enhances peri‑operative management and reduce exposure to blood products in similar settings.\u003c/p\u003e\u003ch2\u003eLevel of evidence\u003c/h2\u003e\u003cp\u003eIII.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Tranexamic Acid in Primary Hip and Knee Arthroplasty: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 14:23:23","doi":"10.21203/rs.3.rs-8150317/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5e497bc-4434-4cc7-8bab-3ee1eb2ccf08","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-21T16:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 14:23:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8150317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8150317","identity":"rs-8150317","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}