Tranexamic acid administration during total joint arthroplasty surgery is not associated with an increased risk of perioperative seizures: a national database analysis

Reg Anesth Pain Med. 2020 Jul;45(7):505-508. doi: 10.1136/rapm-2020-101301. Epub 2020 May 6.


Background: Tranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature.

Methods: After institutional review board approval, we queried a large national database to identify patients who had undergone total hip and total knee arthroplasties (2012-2016). Patients were divided based on their exposure to TXA and history of seizures. The main outcome of interest was a perioperative seizure. We conducted univariable comparisons and a multivariable regression analysis to elucidate a potential independent association between TXA administration and seizures in the perioperative period (with or without a history of seizures).

Results: TXA was used overall in 45.9% (n=4 21 890) of joint arthroplasty recipients (n=9 18 918), with more frequent use over time. Utilization rates did not differ between those with and without a history of seizures; 42.2% (3487/8252) of patients with a seizure history received TXA. Rates of perioperative seizure were low and did not differ between those who did and did not receive TXA (0.01% vs 0.02%, p=0.11); when subgrouping patients by history of seizures, we found no difference in incidence of perioperative seizures between groups (0.06% vs 0.02%, p=0.39). Our adjusted analysis further confirmed these results.

Conclusion: Despite increasing TXA utilization in total joint arthroplasty, we found an overall low seizure incidence. TXA use was not associated with elevated odds of perioperative seizure, even in patients with history of seizure.

Keywords: pharmacology: other; statistics; surgical outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifibrinolytic Agents* / adverse effects
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Blood Loss, Surgical / prevention & control
  • Humans
  • Seizures / chemically induced
  • Seizures / diagnosis
  • Seizures / epidemiology
  • Tranexamic Acid* / adverse effects


  • Antifibrinolytic Agents
  • Tranexamic Acid