Perioperative Tranexamic Acid Treatment and Risk of Cardiovascular Events or Death After Total Hip Arthroplasty: A Population-Based Cohort Study from National Danish Databases

J Bone Joint Surg Am. 2018 Oct 17;100(20):1742-1749. doi: 10.2106/JBJS.17.01518.


Background: There have been concerns that the antifibrinolytic drug tranexamic acid (TXA) might increase the postoperative risk of cardiovascular events. Our objective was to determine whether perioperative TXA use is associated with cardiovascular events and death within 30 days after primary total hip arthroplasty (THA).

Methods: We conducted a nationwide cohort study of cardiovascular outcomes after perioperative exposure to tranexamic acid during THA. We included 45,290 patients who had a THA in the study period of 2006 to 2013; 38,586 received perioperative TXA, and 6,704 did not. Propensity scores were calculated on the basis of age, sex, income, year of surgery, Elixhauser comorbidity index, and a variety of comorbidities and coprescribed medications. The primary outcome was venous thromboembolism. The secondary outcomes were deep venous thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and all-cause mortality. Data were analyzed using Cox regression, either in a multivariable model with inclusion of covariates (full cohorts) or in propensity-score-matched cohorts.

Results: After propensity score matching, all prognostic covariates balanced well. In the matched cohort, TXA use was not found to significantly increase the risk of venous thromboembolism (hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 0.83 to 1.68), deep vein thrombosis (HR = 1.15; CI = 0.78 to 1.68), pulmonary embolism (HR = 1.50; CI = 0.60 to 3.78), myocardial infarction (HR = 0.83; CI = 0.46 to 1.50), ischemic stroke (HR = 0.89; CI = 0.39 to 2.01), or all-cause mortality (HR = 0.73; CI = 0.41 to 1.28). Similar results were found in the multivariable Cox regression analyses.

Conclusions: Our data do not support a detrimental effect of TXA on the risk of cardiovascular events or death following THA.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Aged
  • Antifibrinolytic Agents / adverse effects*
  • Arthroplasty, Replacement, Hip / mortality*
  • Cardiovascular Diseases / chemically induced*
  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Databases, Factual
  • Denmark
  • Female
  • Humans
  • Male
  • Middle Aged
  • Perioperative Period
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / epidemiology*
  • Risk Assessment
  • Time Factors
  • Tranexamic Acid / adverse effects*
  • Venous Thromboembolism / chemically induced
  • Venous Thromboembolism / epidemiology


  • Antifibrinolytic Agents
  • Tranexamic Acid