An operation on the Hüft- or knee joint means für many people a großen step towards more mobility and quality of life. At the same time these are procedures that are associated with a certain risk – especially the risk of blood loss. Previously it was almost self‑evident that patients after a hip prosthesis (Hüft-TEP) or a knee prosthesis (Knie-TEP) a blood transfusion required. Today, thanks to modern medication and surgical techniques, this is almost no longer the case. One of the decisive factors for this is the Tranexamic acid.

In this comprehensive guide you will learn:

• What tranexamic acid is and how it works.
• How it is used in endoprosthetics (hip and knee prostheses).
• Why it is considered a 'game changer'.
• What side effects and contraindications there are.
• What the term off-label use means and why it is important for patients.
• Why the ENDOPROTHETICUM Rhein-Main uses tranexamic acid to ensure maximum safety.

History and development of tranexamic acid

The tranexamic acid was developed in the 1960s in Japan. Researchers were then looking for a medication that could inhibit the breakdown of blood clots. Soon it was discovered that the active ingredient could help in surgeries, injuries, and also heavy menstrual bleeding. Under the trade name Cyclokapron® tranexamic acid has been on the market for many decades and is tested worldwide.

In orthopaedic surgery and trauma surgery, its use has only really become established over the last two decades. Only when studies clearly showed that tranexamic acid can significantly reduce bleeding did it become a standard component of endoprosthetics, particularly in the implantation of hip and knee replacements.

How does blood coagulation work?

To understand why Tranexamsäure is so effective, it is worthwhile to look at the body's own blood clotting. If a blood vessel is injured, the body tries to stop the bleeding immediately. In doing so, three processes work together:

1. Vasoconstriction: The blood vessels constrict.
2. Platelets (Thrombocytes) adhere to the injured site.
3. Fibrin – a kind of „glue“ – ensures that a stable blood clot forms.

To maintain blood circulation, the Körper also has mechanisms to dissolve clots again. This process is Fibrinolysis called. Exactly here the Tranexamsäure acts: It inhibits the enzyme Plasmin, which für the breakdown of clots is responsible. Thus the clots remain stable, and the bleeding hört more quickly.

How is Tranexamic acid administered?

Depending on the clinic and patient, there are different methods:

• Intravenös (i.v.): The substance is administered über the vein directly into the blood. Usually this occurs shortly before or während the operation.
• Oral (Tablets): In some clinics, patients are given tablets before or after surgery. Studies show that this form can be just as effective.
• Local / intra-articular: With this method tranexamic acid is injected directly into the operative area – e.g. into the knee joint – injected. This acts specifically at the site of bleeding.

Many clinics combine for hip prostheses and knee prostheses the intravenous and local application, to enhance the effect. This combination is considered especially safe and effective.

Tranexamic acid as a game changer in endoprosthetics (hip replacement, knee replacement)

Just 15 years ago, it was common for many patients to require a blood transfusion after surgery on the hip or knee joint. While these blood transfusions saved lives, they also carried risks: risk of infection, immune reactions, and sometimes even organ strain.

Since the introduction of tranexamic acid, these risks have been drastically reduced:

• The transfusion rates are below 5 % dropped.
• Patients can be mobilized more quickly.
• Complications such as infections or circulatory problems occur less frequently.

In combination with minimally invasive surgical techniques and the modern fast-track concepts (rapid rehabilitation) tranexamic acid is a central building block for safe endoprosthetics.

Tranexamic acid and Fast-Track concepts in endoprosthetics

The modern Fast-Track concept – sometimes also „Enhanced Recovery After Surgery“ (ERAS) called – aims to enable patients after a hip-TEP or knee-TEP operation to become mobile and independent as quickly as possible. Every hour you get up and walk earlier reduces the risk of complications such as thrombosis, lung infections or muscle loss.

Here the Tranexamsäure plays a key role:

• Less blood loss means less weakness and circulatory problems.
• Patients need less frequent blood transfusions, which otherwise could additionally strain the circulatory system.
• Through the more stable circulatory system you can get up earlier and do walking exercises.
• Rapid mobilization in turn reduces the risk of infection and accelerates healing.

In short: Tranexamic acid is a crucial building block for fast-track concepts in endoprosthetics to work at all. It makes modern "fast recovery" safe and effective.

Why is the use of tranexamic acid partially considered off-label use?

Although Tranexamic acid has been approved for decades, the approval does not automatically cover all conceivable uses. The intra‑articular administration (i.e., direct injection into the joint) is, for example, not officially included in the approval in Germany. If it is still used, for instance in the context of a Hüft-TEP or knee-TEP, it is referred to as a "off label use".

This means that doctors are allowed to use the method, but they must inform you about it in advance. As a patient, you will know exactly that it is a safe and proven method, but it is not explicitly approved by the drug authority.

Contraindications – when is Tranexamic acid not given?

Tranexamic acid is a very safe medication. Nevertheless, there are situations in which it is not recommended:

• Severe kidney diseases: Here the active ingredient can accumulate in the body.
• Thromboses or pulmonary embolisms in the medical history.
• Epileptic seizures: Tranexamic acid can, under certain circumstances, provoke seizures.

Before the operation, your doctor checks whether an application makes sense for you. This clarification is part of the safety standard.

Safety of Tranexamic acid – what do studies say?

Numerous international studies have shown that tranexamic acid the risk of thrombosis or embolism does not increase. This was a long-time concern of many physicians. Today it is established: the benefits clearly outweigh, and safety is high. Therefore tranexamic acid is now worldwide a standard for joint replacement surgeries such as hip prostheses or knee prostheses.

Patient Questions (FAQ)

1. Should I be afraid of side effects?
No, in the vast majority of cases tranexamic acid is well tolerated. Your doctor checks before the operation whether you have risk factors.

2. Do I get less pain because of this?
Tranexamic acid is not analgesic. However, due to the reduced blood loss you become fit again more quickly and can start rehabilitation earlier.

3. Is the medication expensive?
No, Tranexamic acid is a very inexpensive medication – especially compared to the costs and risks of a blood transfusion.

4. Do I receive the treatment automatically?
In most specialized clinics, Tranexamic acid is now part of the standard therapy. Talk to your medical team about it directly. The use is explained to you before the operation.

Tranexamic acid and modern endoprosthetics in Mainz

In ENDOPROTHETICUM Rhein-Main under the leadership of Prof. Dr. Karl Philipp Kutzner focuses on hip and knee prostheses with the highest safety. Here, tranexamic acid is naturally part of the treatment concept. Together with minimally invasive techniques and gentle rehabilitation programs, a holistic approach for a successful operation emerges.

Summary

• Tranexamic acid (Cyclokapron®) is a medication that effectively reduces bleeding during surgeries.
• It is used in hip prostheses and knee prostheses used – intravenous, oral or local.
• Thanks to it, blood transfusions are almost unnecessary today in primary hip TEP or knee TEP operations.
• Some applications are considered off-label, but require only a brief clarification.
• Studies confirm: The risk of thrombosis is not increased.
• Patients benefit from greater safety and faster recovery.

Conclusion: Tranexamic acid is a gamechanger in modern endoprosthetics

Would you like a modern hip or knee prosthesis with maximum safety? Then you are at ENDOPROTHETICUM Rhein-Main in Mainz just right. Under the direction of Prof. Dr. Karl Philipp Kutzner you receive an individual consultation and a therapy according to the latest scientific standards – self‑evidently including the use of Tranexamic acid.

👉 Schedule your appointment now: www.endoprotheticum.de