Tranexamic acid to minimise blood loss following shoulder replacement

Tranexamic acid to minimise blood loss

for primary elective hip or knee replacement:

• give intravenous tranexamic acid
• If there is no renal impairment, also apply 1 g to 2 g of topical (intra-articular) tranexamic acid [1]diluted in saline after the final wash-out and before wound closure. Ensure that the total combined dose of tranexamic acid does not exceed 3 g
• if there is renal impairment[2], give a reduced dose of intravenous tranexamic acid on its own

for primary elective shoulder replacement:

• consider intravenous tranexamic acid
• if there is no renal impairment, consider 1 g to 2 g of topical (intra-articular) tranexamic acid [1] diluted in saline applied after the final wash-out and before wound closure. Ensure that the total combined dose of tranexamic acid does not exceed 3 g
• if there is renal impairment[2] and tranexamic acid is used, give a reduced dose of intravenous tranexamic acid on its own

Notes:

[1] At the time of publication (June 2020), tranexamic acid solution for injection did not have a UK marketing authorisation for topical (intra-articular) use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing unlicensed medicines for further information.
[2] Mild to moderate renal impairment. See the summary of product characteristics for dosage reductions according to serum creatinine level. Tranexamic acid is contraindicated for people with severe renal impairment.

Reference:

• NICE (June 2020). Joint replacement (primary): hip, knee and shoulder