The use of tranexamic acid in foot and ankle surgery

J. Brousil, T. Keith, A. Robinson

Introduction: The role of tranexamic acid in foot and ankle surgery has yet to be established. Its use in elective hip and knee arthroplasty and trauma is well documented. The safety and efficacy of the drug in these applications has been proven thanks to large scale high quality feasibility studies. We present a study demonstrating the safe use of tranexamic acid in setting of foot and ankle surgery.

Methods: Over an 18 month period all patients undergoing major foot and ankle reconstructions received an intraoperative dose of tranexamic acid (1g IV infused over 2 minutes). All patients deemed at significant risk of developing a haematoma or wound dehiscence received the drug. These cases were a mix reflected a tertiary UK foot and ankle practice. Case notes were interrogated for patient demographics, thrombosis history, anticoagulation history and wound related complications.

Results: 81 patients were identified as having received 1 g of tranexamic acid intraoperatively. Of these patients the primary pathology in 55% was degenerative (n= 45), 2.5% Diabetes related reconstruction (n=3), 17% were traumatic (n=14) and 23% for deformity (n=19). Five patients (6%) experienced a wound complication, all of which were minor. No patient required a return to theatre and no clinically significant post-operative thrombo-occlusive events were recorded.

Discussion: The use role of tranexamic acid is not yet routine during surgery about the foot and ankle. Its role has been clearly established in trauma and large joint arthroplasty. Similar beneficial effects can be seen in this series of trauma and elective foot and ankle patients. No adverse events occurred.

Conclusion: Tranexamic acid can be safely administered to patients undergoing the full spectrum foot and ankle surgery with minimal risk of adverse events. Further work is required to determine a positive relationship on wound healing complications.