Quality standard
Statement 3: Tranexamic acid during hip and knee replacement
Statement 3: Tranexamic acid during hip and knee replacement
Rationale
Tranexamic acid helps to minimise blood loss during hip and knee replacement surgery and can reduce the need for blood transfusion.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of clinical protocols to ensure that adults who are having hip or knee replacement are given tranexamic acid during surgery.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from clinical protocols.
Process
Proportion of hip or knee replacement operations during which tranexamic acid is given.
Numerator – the number in the denominator during which tranexamic acid is given.
Denominator – the number of hip or knee replacement operations.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
Blood transfusion rates associated with hip or knee replacement surgery.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records and electronic prescribing systems.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that systems are in place so that adults having hip or knee replacement are given tranexamic acid during surgery.
Healthcare professionals (anaesthetists and orthopaedic surgeons) give tranexamic acid to adults (unless contraindicated) who are having hip or knee replacement. Anaesthetists administer intravenous tranexamic acid at the start of surgery and the orthopaedic surgeon applies it topically before wound closure.
Commissioners ensure that they commission services that give tranexamic acid to adults who are having hip or knee replacement.
Adults who are having hip or knee replacement surgery are given tranexamic acid during their operation. This helps blood to clot and reduces blood loss during surgery.
Source guidance
Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157 (2020), recommendation 1.4.1
Definitions of terms used in this quality statement
Tranexamic acid
The administration and dose varies according to whether or not adults having hip or knee replacement have renal impairment.
If there is no renal impairment:
-
give intravenous tranexamic acid, and
-
apply 1 g to 2 g of topical (intra-articular) tranexamic acid 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.
See the BNF or summary of product characteristics for the dosage of intravenous tranexamic acid.
For adults with mild to moderate renal impairment, give a reduced dose of intravenous tranexamic acid on its own, based on their serum creatinine level, as defined in the summary of product characteristics.
Severe renal impairment is one of the contraindications to tranexamic acid. [NICE's guideline on joint replacement (primary), recommendation 1.4.1]. For further contraindications, please check the summary of product characteristics.
In March 2022, topical (intra-articular) use of tranexamic acid was off label. See NICE's information on prescribing medicines.