Oral TXA Is Equally Effective at Preventing Blood Loss in Orthopedic Surgery, Interim Study Finds


Intermediate results from a study conducted by researchers at the Hospital for Special Surgery (HSS) suggest that oral tranexamic acid (TXA) is not inferior to intravenous (IV) TXA in preventing blood loss during total knee and hip arthroplasty. These results were presented at the spring 2021 annual meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA).

Previously available information suggests that oral, IV, and topical ATX are all effective in reducing blood loss and dramatically lowering blood transfusion rates during and after surgery, but research with direct comparisons for each method is limited.

ATX in orthopedic surgery has become the standard of care. However, the most efficient, effective and cost-effective method of administration remains unknown. Oral administration of TXA is logistically easier, reducing the risk of medication errors in the operating room. It is also less expensive. We’re doing this study to find out if oral ATX is also just as effective in preventing blood loss. If this is the case, oral administration of the drug preoperatively as a single dose may become the standard of care. “

Stavros Memtsoudis, MD, PhD, MBA, Principal Investigator, Anesthesiologist at HSS

Dr Memtsoudis and colleagues randomized 199 patients aged 18 to 80 undergoing total hip or knee replacement surgery to either receive oral TXA (1950 mg) two hours before surgery or TXA IV (1 g). at the start of the procedure. The main outcomes observed were blood loss and transfusion rates.

In patients with total hip replacement surgery, the estimated post-anesthesia care unit (PACU) blood loss for oral ATX was 534 ± 285 mL compared to 676 ± 550 for IV ATX. On the first postoperative day, the estimated blood loss was 769 ± 257 ml for oral TXA and 798 ± 302 ml for IV TXA.

In patients with total knee replacement surgery, the estimated blood loss in the PACU was 289 ± 219 ml for oral TXA and 486 ± 670 ml for IV TXA. On the first postoperative day, the estimated blood loss was 716 ± 288 ml for oral ATX versus 846 ± 659 ml for ATX IV.

No patient received a transfusion during surgery. A patient who received TXA IV received a transfusion after surgery.

“Based on our interim results, it appears that the oral version of TXA is just as effective as intravenous administration. This translates into improvements in efficiency, cost and safety, all of which are important to patients, clinicians and policy makers, ”Dr Memstoudis mentioned. “The research seems pretty clear at this point. However, a uniform translation into policy is what is needed, as there appears to be a limited translation of the best evidence into practice.”

The full results of this study will be analyzed later this year.


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