ATE Risk
There is a paucity of randomized clinical trials on the risk of ATE due to the administration of TXA intravenously, topically, and orally. However, the existing evidence does not suggest that TXA increases the risk of developing an ATE 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

Rationale
Arterial thromboembolic events following primary hip or knee arthroplasty are exceptionally infrequent complications and are rarely reported in the randomized clinical trials as most patients who have known risk factors for these events are often excluded from these types of studies. In a direct meta-analysis investigating arterial and venous thromboembolic events, only 9 studies reported the incidence of ATE.12 Due to the limited number of studies, the authors performed combined hip and knee arthroplasty direct meta-analysis only. The results demonstrated no statistical difference in the risk of ATE between IV or topical TXA and placebo.12

Although the direct meta-analysis was limited to high-quality studies, we are only able to provide “moderate” support to our recommendation. The combination of paucity of data, lack of studies specifically designed to investigate the complication of ATE, and exclusion of patients with known risk factors among those studies that were available, diminished our ability to provide for a stronger recommendation and an individual riskbenefits assessment will be necessary.

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