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- Talk
- UK
Interview with Dr Rafael Sierra - Tranexamic Acid to Minimise Blood Loss in Primary Arthroplasty
Description
In this insightful discussion, Jonathan Howell and Professor Tim Board engage Dr. Rafael Sierra, an orthopedic expert from the Mayo Clinic, to unpack the recent NICE guidelines regarding the use of tranexamic acid (TXA) to minimize blood loss during surgeries. Dr. Sierra, renowned for his extensive research and publications on the subject, explains the fundamental mechanism of TXA as an antifibrinolytic agent that prevents the breakdown of fibrin clots, thus minimizing blood loss in procedures such as total hip and knee replacements.
The trio delves into the robust evidence supporting the use of TXA, highlighting various randomized controlled trials and meta-analyses that demonstrate its effectiveness at reducing blood loss and the need for transfusions during surgeries. Dr. Sierra emphasizes that despite TXA's remarkable benefits, its application in orthopedic surgery is classified as off-label by the FDA, as it is primarily approved only for patients with hemophilia undergoing dental procedures.
Throughout the conversation, the focus shifts to the importance of administering TXA correctly, discussing optimal dosing protocols and the implications of renal impairment. The discussion also addresses concerns around potential complications associated with TXA, particularly thromboembolic events, which Dr. Sierra argues are not significantly heightened by TXA use.
The dialogue concludes with reflections on the medicolegal responsibilities and decisions surgeons face regarding TXA administration, underscoring the critical role that clinical judgment plays in optimizing patient outcomes.