Risk-stratified perioperative tranexamic acid utilization for total hip and knee arthroplasty: Analysis of trends of the past decade.

PURPOSE The purpose of this study was to evaluate changes in perioperative tranexamic acid (TXA) utilization among patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), based on patient demographics and comorbidities, including those at higher and lower risk of venous thromboembolism (VTE). METHODS Patients who underwent THA or TKA between 2012 and 2021 were identified using the TriNetX electronic health record database. Perioperative TXA use was evaluated among patients stratified according to risk of VTE. Utilization rates were analyzed using compound annual growth rates (CAGRs) and linear regression analysis. RESULTS From 2012 to 2021, TXA use increased by 406% (CAGR: +17.66%; P < 0.001) for THA and 459% for TKA (CAGR: +18.86%; P < 0.001). Among patients with at least 1 factor placing them at high risk of VTE, TXA use increased by 1277% for THA (CAGR: +30.0%; P < 0.001) and by 966% for TKA (CAGR: +26.7%; P < 0.001). During the final study year (2021), surgeons overall used TXA in 67.8% of THA cases and 62.5% of TKA cases. In the high-risk group, TXA use was lowest among patients with a history of myocardial infarction (THA, 48.7%; TKA, 51.4%), cerebrovascular accident (THA, 51.0% and TKA, 50.6%), bleeding or clotting disorder (THA, 57.4% and TKA, 57.1%), or previous VTE (THA, 57.3%; TKA, 53.6%). CONCLUSION Despite the rapid growth in TXA utilization over the past decade in THA and TKA, patients at high risk of VTE and ischemia are still less likely to receive perioperative TXA.

• Publication year

  2026

• Venue

  Bulletin of the Hospital for Joint Diseases

• Publication date

  2026-01-20

• Fields of study

  Medicine

• Identifiers
  DOI 10.1097/bh9.0000000000000038PMID 41656074PMCID PMC12975013
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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