LAUSR

To the Editor: Tranexamic acid (TXA) has recently become popular for use in orthopedic surgeries owing to its ef fi cacy in reducing blood loss, transfusion rates, and mortality without increasing the risk of deep venous thrombosis. [1] Although the ideal dosage and route for TXA administration remain unclear, it has become one of the most important parts of the perioperative blood conservation strategy. However, it remains controversial to prescribe TXA to patients with cardiovascular diseases, because of prothrombotic and proconvulsant effects, which potentially increases cardiovascular risk. Atrial fi brillation (AF), being the most common sustained cardiac arrhythmia, affects over 33 million individuals worldwide and is associated with a fi vefold increase in the risk of stroke. [2] Oral anticoagulants are administered to these patients toward preventing stroke and systemic embolism, and anticoagulant therapy would increase the perioperative blood loss during total joint arthroplasty. Although a previous study demonstrated no detrimental effect of TXA on the risk of cardiovascular events and death following total hip arthroplasty, the population investigat-ed in that study included patients without cardiovascular diseases, which might cover up the real incidence of postoperative cardiovascular complication in these patients and thereby lead to statistical bias. [1] Therefore, the retrospective cohort study aimed to assess the effects of perioperative TXA administration on cardiovascular occlusive events, perioperative resuscitation in patients with AF undergoing total joint arthroplasty. This study was conducted