Oral, IV Tranexamic Acid Compared for Joint Replacement Surgery

Interim results of a randomized study indicate that oral and IV TXA are equally effective in reducing perioperative blood loss
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WEDNESDAY, May 26, 2021 (HealthDay News) -- Oral tranexamic acid (TXA) appears as effective as intravenous (IV) TXA in preventing blood loss in patients undergoing total knee and total hip replacement surgery, according to a study presented at the annual Regional Anesthesiology and Acute Pain Medicine Meeting, held from May 13 to 15 in Lake Buena Vista, Florida.

Julia F. Reichel, from the Hospital for Special Surgery in New York City, and colleagues compared the efficacy of a single preoperative oral dose of TXA to a single preoperative IV dose of TXA in patients undergoing total joint replacements. The analysis included 200 adults undergoing total hip arthroplasty (THA) via a posterior approach or total knee arthroplasty (TKA) and receiving regional anesthesia (neuraxial).

The researchers found that among THA patients, estimated blood loss for oral versus IV TXA in the postanesthesia care unit was 534 mL versus 676 mL, while the values were 769 mL versus 798 mL by postoperative day (POD) 1. For patients undergoing TKA, estimated blood loss for oral versus IV TXA in the postanesthesia care unit was 289 mL versus 486 mL, and 716 mL versus 846 mL on POD 1. No group needed intraoperative transfusions; however, one patient in the TKA + IV TXA group received a postoperative transfusion.

"Given our interim results, it seems that the oral version of TXA 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," principal investigator Stavros Memtsoudis, M.D., Ph.D., said in a statement. "The research seems rather 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."


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