Tranexamic acid and orthopedic surgery—the search for the holy grail of blood conservation

Over the last decade an increasing amount of literature regarding the perioperative use of tranexamic acid (TXA) for bleeding control in orthopedic surgery has been published (1-6). While clinical trials found promising results regarding the reduction of blood loss and therefore a reduced rate of blood transfusions, concerns regarding prothrombotic adverse events including deep vein thrombosis, myocardial infarction, pulmonary embolism and cerebrovascular events have continued to dampen the enthusiasm and thus recommendations for wide spread use (7).