VTE Risk (Patients Without History)
Administration of IV, topical, and oral TXA in patients without a known history of a VTE does not increase the risk of developing a VTE compared to placebo during the perioperative episode of a primary TJA.
Tranexamic Acid in Total Joint Arthroplasty
Developed by the American Association of Hip and Knee Surgeons

Direct meta-analysis investigating the impact of TXA administration on the risk of VTE was performed utilizing 77 high and one moderate quality randomized clinical trial. Of those, 92% of the studies utilized history of a thromboembolic event as an exclusion criterium.12 Individual results for hip and knee arthroplasty demonstrated no significant difference between all methods of TXA administration compared to placebo.12 Since individual studies included were noted to be comprised of small sample sizes, the hip and knee arthroplasty populations were combined to analyze for differences between IV and topical application of TXA in order to comment on the incidence of rare complications like VTE.12 This combined analysis further supports the group’s conclusion that there is no evidence of increased risk of VTE with TXA administration (combined results had a relative risk closer to “no difference” than the subgroup analysis).12 Given this overwhelming evidence, we provide “strong” support to our recommendation that TXA administration at doses typically utilized in hip and knee arthroplasty is not associated with an increased risk of VTE for patients without a known history of VTE.