Oral tranexamic acid is just as effective as intravenous tranexamic acid (TXA) in preventing blood loss in total knee and total hip replacement surgery, according to recent data from the Hospital for Special Surgery.
The study, “The Effect of Oral Versus Intravenous Tranexamic Acid on Perioperative Blood Loss in Joint Arthroplasty Patients,” was presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine Annual Meeting.
While past research has also suggested that oral, IV and topic tranexamic acid are all effective at reducing blood loss and the need for blood transfusions, studies with direct comparisons of each method have been limited.
“The oral administration of tranexamic acid is logistically easier, thus reducing the risk of drug errors in the OR. It is also less costly. We are performing this study to identify if oral tranexamic acid is also equally efficacious at preventing blood loss. If this is the case, oral administration of the drug preoperatively as a one-time dose could become standard of care,” said Stavros Memtsoudis, M.D., Ph.D., MBA, an anesthesiologist at Hospital for Special Surgery.
For the study, almost 200 patients between the ages of 18 and 80 who were undergoing total hip or total knee replacement received either oral tranexamic acid (1950 mg) two hours before surgery or IV tranexamic acid (1g) at the beginning of the surgery. Primary outcomes included blood loss and transfusion rates.
The estimated blood loss for the hip replacement patients in the post anesthesia care unit was 534 ± 285 mL for oral tranexamic acid and 676 ± 550 for IV tranexamic acid.
On postoperative day one, the estimated blood loss was 769 ±257 mL for oral tranexamic acid and 798 ± 302 mL for IV tranexamic acid.
For the knee replacement patients, the estimated blood loss in the post anesthesia care unit was 289 ± 219 mL for oral tranexamic acid and 486 ± 670 mL for IV tranexamic acid.
On postoperative day one, their estimated blood was 716 ± 288 mL for oral tranexamic acid versus 846 ± 659 mL for IV tranexamic acid.
Overall, none of the patients needed a transfusion during surgery. One patient who had received IV tranexamic acid did need a transfusion after surgery.
“Given our interim results, it seems that the oral version of tranexamic acid is equally as effective as intravenous administration. This translates to improvements in efficiency, cost and safety, all of which are important for patients, clinicians and policy makers,” Memstoudis said. “The research seems clear at this point. However, a uniform translation into policy is what is needed, as there seems to be limited translation of best evidence into practice.”
The researchers said that the complete results of this study will be analyzed later this year.
