To evaluate the effect of intraoperative tranexamic acid (TXA) use on postoperative coagulation and fibrinolysis function following lower extremity joint arthroplasty.

This retrospective cohort study included the patients who underwent lower limb joint replacement surgery at the Affiliated Kunshan Hospital of Jiangsu University between April 2018 and February 2021. Inclusion criteria: patients indicated for lower-limb arthroplasty (total knee, unicompartmental knee, hemiarthroplasty, or total hip) with no contraindications to tranexamic acid or the study anticoagulants. Exclusion criteria: allergy or contraindication to tranexamic acid or any study anticoagulant; past or current coagulopathy or bleeding tendency; concomitant use of drugs that affect anticoagulation or increase bleeding risk; severe renal impairment (creatinine clearance <30 ml/min); active or prior peptic ulcer/gastrointestinal bleeding within six months; or venous thromboembolism (e.g., deep vein thrombosis, pulmonary embolism) within the past year. Data on preoperative and postoperative 48-hour blood routine, biochemical markers, and coagulation indicators were collected. Patients were divided into different groups based on the use of TXA. The outcomes measured included postoperative hemoglobin, hematocrit, transfusion rate, and coagulation indicators. Data between groups were compared using t-tests or Mann-Whitney U rank-sum tests for continuous variables, and chi square tests for categorical variables.The independent effect of intraoperative tranexamic acid (TXA) use on postoperative hemoglobin levels, transfusion rates, and coagulation indicators after sequential administration of different anticoagulants, controlling for confounding factors using logistic and multiple linear regression.

A total of 403 patients were enrolled. Among them, 190 patients received tranexamic acid (TXA) intraoperatively, while 213 patients did not. Postoperative anticoagulation was achieved with low-molecular-weight heparin in 294 patients and with oral anticoagulants in 109 patients. The TXA group had significantly higher postoperative hemoglobin (111.25 ± 18.35) g/L and hematocrit (34.38%) compared to the control group [(106.25 ± 18.42) g/L, 32.91%] (t=-2.65, P=0.009; t=-2.26, P=0.024). The transfusion rate in the TXA group was 8.84%, significantly lower than the 19.19% observed in the control group (χ²=8.294, P<0.05). Logistic regression analysis showed that TXA use reduced the risk of moderate postoperative anemia [odds ratio (OR)=0.34, 95%CI (0.17, 0.69), P=0.003] and decreased transfusion requirements [OR=0.34, 95%CI (0.17, 0.68), P=0.002]. Multiple linear regression analysis showed that intraoperative TXA and postoperative sequential anticoagulation with different types of anticoagulants had no significant effect on postoperative coagulation parameters.

TXA administration improves postoperative hemoglobin levels, reduces transfusion requirements, and lowers the risk of moderate anemia in patients undergoing lower limb joint replacement surgery. In the context of sequential anticoagulants following surgery, TXA use did not increase the risk of postoperative coagulation abnormalities, indicating its effectiveness in reducing bleeding while maintaining a favorable safety profile.