Publication date: Sep 05, 2025
The safety of tranexamic acid (TXA) in patients with recent coronavirus disease (COVID-19) infection undergoing major arthroplasty remains unclear. We aimed to evaluate whether TXA increases thromboembolic risk in post-COVID-19 patients undergoing major arthroplasty. Using the TriNetX database, we identified patients aged ≥50 years who underwent total knee or hip arthroplasty with documented COVID-19 within 3 months prior to surgery. Patients who received TXA on the day of surgery were compared with those who did not. The primary outcome was 6-month risk of venous thromboembolism (VTE), with secondary outcomes including cerebral infarction, mortality, intensive care unit (ICU) admission, acute kidney injury (AKI), sepsis, and pneumonia. After matching (26,366 patients for each group), analysis revealed that TXA use was not associated with an increased risk of VTE (odds ratio [OR] 1. 09, 95% confidence interval [CI] 0. 90-1. 32, P = . 404), cerebral infarction (OR 0. 86, 95% CI 0. 67-1. 09, P = . 215), mortality (OR 0. 81, 95% CI 0. 60-1. 10, P = . 174), or other complications at 6 months. Notably, TXA was associated with a significantly reduced risk of ICU admissions (OR 0. 74, 95% CI 0. 62-0. 89, P = . 001). Sensitivity analysis showed that TXA provided additional benefits in patients with prior COVID-19 hospitalization, including reduced mortality (OR 0. 53, P = . 003), lower risk of AKI (OR 0. 79, P = . 002), and decreased incidence of sepsis (OR 0. 77, P = . 038). Sex-based analysis revealed more pronounced benefits in female patients, particularly for ICU admission and AKI. TXA use in post-COVID patients undergoing major arthroplasty was associated with better long-term outcomes without increasing thromboembolic risk, supporting the continued use of TXA in this patient population.