“Let’s step outside to settle this.” While this pugilistic phrase is most commonly seen in Hollywood movies, it is rarely heard in the professional confines of an operating room. However, just a decade ago, one of us found themselves uttering it during a dialogue with a new orthopedic surgeon recommending the use of tranexamic acid for an elective hip replacement. This was a medication the anesthesiologist knew well from their liver transplant patient population but had never administered for a joint replacement. It seemed inappropriate to have this discussion in front of an awake patient. While only 4% of patients undergoing elective lower extremity joint replacement in 2011 received tranexamic acid, nearly three quarters were receiving it in 2016, and it is now recommended routine practice in consensus guidelines.

In this issue of Anesthesiology,...

You do not currently have access to this content.