November 1, 2016 – Elizabeth Hofheinz, M.P.H., M.Ed.
When researchers from the University of Michigan Medical Center looked into it, they found that the use of tranexamic acid (TXA) in their state varied widely and that the data suggested that TXA had a significant effect on the risk of transfusion. Brian R. Hallstrom, M.D. is associate chair for Quality and Safety in the Department of Orthopaedic Surgery at the University of Michigan Medical Center. He commented to OTW, “One of our first quality improvement projects in the Michigan Arthroplasty Registry was reducing unnecessary blood transfusion.”
The team had plenty of cases to work with: 23,236 primary total knee arthroplasty cases and 11,489 primary total hip arthroplasty cases in the MARCQI (Michigan Arthroplasty Registry: Collaborative Quality Initiative).
Dr. Hallstrom, co-director of MARCQI, added, “The adoption of TXA into orthopaedic practices has been slow due to concerns among surgeons and anesthesiologists about the potential risks of the medication. We found the TXA group received significantly fewer blood transfusions. In addition, our large, statewide experience supports other smaller studies that have not shown an increase in blood clots or cardiovascular events. In fact, we found an association with fewer blood clots in knee replacement patients and fewer readmissions in hip replacement patients.”
“Published rates of transfusion after hip and knee replacement have historically been quite high. TXA offers one tool to help surgeons reduce the need for blood transfusion which will reduce risk to patients, stress on the blood supply and cost to the system.”
“The combination of multimodal pain control, rapid rehabilitation and reduced blood loss and swelling has really revolutionized the care of hip and knee replacement patients over the last few years. These and other factors will only serve to improve the quality and value of care for the many patients having these remarkable, life changing procedures as we move into the next era of health care.”
Great Results for Novel Osteoporosis Therapy
A new study utilizing data from the ACTIVE (Abaloparatide Comparator Trial in Vertebral Endpoints) trial has found that regardless of bone density, age, and previous history of fracture, abaloparatide-SC offers consistent protection against bone fractures in postmenopausal women.
Felicia Cosman, M.D. is an osteoporosis specialist and medical director of the Clinical Research Center at Helen Hayes Hospital, senior clinical director of the National Osteoporosis Foundation and professor of medicine at Columbia University.
Dr. Cosman commented to OTW, “Some patients with osteoporosis who might be candidates for abaloparatide treatment have prior fractures from osteoporosis whereas others have very low bone density without a fracture history. In this study we sought to determine whether abaloparatide would work similarly well in both groups of women. Furthermore, we believed it was important to show that abaloparatide could work in younger patients as well as the very old and to demonstrate that abaloparatide could reduce fractures in women who had either low spine and/or low hip BMD [bone mineral density].”