A study of 872, 116 total hip and knee replacement procedures performed at 510 U.S. hospitals between 2006 and 2012 revealed that doctors were doing the right thing where management of blood was concerned. Under examination was the use of a decades-old clotting drug that, while it reduced the need for blood transfusions during and after replacement surgeries, it also prevented enzymes in the body from breaking down blood clots that could cause complications such as thrombosis.
Now for the Good News About Tranexamic Acid

Researchers at Icahn School of Medicine at Mount Sinai and Hospital for Special Surgery published the results of their study online in the British Medical Journal. Their basic take-away was that the use of tranexamic acid was associated with lower rates of admission to an intensive care unit, lower length of hospital stay, and lower costs of hospital stay. A dose of 2000 mg of tranexamic acid appeared to have had the best effectiveness and safety profile.
Lead author of the study Jashvant Poeran, M.D., Ph.D., Assistant Professor, Institute of Healthcare Delivery Science, Department of Population Science, Icahn School of Medicine at Mount Sinai wrote, “Our study, an analysis of past data, found that the use of tranexamic acid in patients undergoing hip or knee replacement surgery was associated with up to a 70% decrease in the need for a blood transfusion, and without an increased risk of complications related to clotting. An increasing number of patients will require these surgeries as America ages, and maintaining their safety is very important.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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