Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

While tranexamic acid (TXA) reduces transfusion in total joint arthroplasty (TJA), it remains unclear whether there is a preoperative hemoglobin (Hgb) threshold above which it is no longer beneficial. 2100 primary TJA patients were retrospectively categorized by preoperative Hgb; 1161 (55%) received TXA. Transfusion rates decreased with TXA in all groups; with Hgb > 15 the transfusion rate was 0.5% with TXA and 4.5% without (P = 0.0086); with Hgb > 11 the transfusion rate was 4.7% with TXA and 18.7% without (P < 0.0001). Patients receiving TXA had a shorter LOS by 0.51 days (P < 0.0001). Patients receiving a postoperative transfusion had a longer LOS by 0.69 days (P < 0.0001). TXA should be considered in all TJA patients independent of preoperative Hgb level.