Tranexamic acid (TXA) utilization during total joint arthroplasty (TJA) has become ubiquitous. However, concerns remain regarding the risk of thrombotic complications. The goal of this study was to examine the risk of prothrombotic complications in patients who received TXA during total knee (TKA) and total hip arthroplasty (THA). The Premier Healthcare Database was queried for patients who underwent elective TJA. TXA utilization trends were described from 2008 to 2020. Two analyses were performed using ICD-10 codes from 2016 to 2020: (1) patients who received TXA compared to patients who did not receive TXA and, (2) to account for surgeon selection bias, patients whose surgeon utilized TXA consistently (≥90% of cases) compared to patients whose surgeons used TXA infrequently (≤30% of cases). Multivariate and instrumental variable analyses (IVA) were performed to assess outcomes while accounting for confounding factors. TXA utilization increased from 0.1% of cases in 2008 to 89.2% in 2020. From 2016 to 2020, 1,120,858 TJAs were identified (62.1% TKA, 27.9% THA), of which 874,627 (78.0%) received TXA. Patients who received TXA were at lower risk of prothrombotic (adjusted Odds Ratio (aOR) 0.82, < .001), bleeding (aOR 0.75, < .001), and infectious complications (aOR 0.91, < 0.001). Furthermore, patients who underwent surgery from surgeons who utilized TXA consistently were at lower risk for prothrombotic (aOR 0.90, < .001) and bleeding (aOR 0.72, < .001) complications. The widespread utilization of TXA during elective TJA was not associated with increased rates of prothrombotic complications. These findings persisted after accounting for surgeon selection bias. Level III.

中文翻译：

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全髋关节和全膝关节置换术后的氨甲环酸和血栓前并发症：考虑外科医生选择偏差的全人群安全性分析

全关节置换术 (TJA) 期间氨甲环酸 (TXA) 的使用已变得无处不在。然而，人们仍然担心血栓并发症的风险。本研究的目的是检查在全膝关节置换术 (TKA) 和全髋关节置换术 (THA) 期间接受 TXA 的患者发生血栓前并发症的风险。在 Premier Healthcare 数据库中查询了接受选择性 TJA 的患者。描述了 2008 年至 2020 年的 TXA 使用趋势。使用 2016 年至 2020 年的 ICD-10 代码进行了两项分析：(1) 接受 TXA 的患者与未接受 TXA 的患者进行比较，(2) 考虑外科医生选择偏差，与外科医生不经常使用 TXA 的患者（≤ 30% 的病例）相比，外科医生持续使用 TXA 的患者（≥90% 的病例）。进行多变量和工具变量分析（IVA）来评估结果，同时考虑混杂因素。 TXA 的使用率从 2008 年占病例数的 0.1% 增加到 2020 年的 89.2%。从 2016 年到 2020 年，共鉴定了 1,120,858 例 TJA（62.1% TKA，27.9% THA），其中 874,627 例（78.0%）接受了 TXA。接受 TXA 的患者发生血栓前风险（调整后优势比 (aOR) 0.82，< .001）、出血（aOR 0.75，< .001）和感染并发症（aOR 0.91，< 0.001）的风险较低。此外，接受持续使用 TXA 的外科医生进行手术的患者发生血栓前并发症（aOR 0.90，< .001）和出血（aOR 0.72，< .001）并发症的风险较低。选择性 TJA 期间 TXA 的广泛使用与血栓前并发症发生率的增加无关。在考虑了外科医生选择偏差后，这些发现仍然存在。三级。