Oral and IV Tranexamic Acid Are Equally Effective, Study Finds
Interim results of a study conducted by researchers at Hospital for Special Surgery suggest that oral tranexamic acid (TXA) is non-inferior to intravenous (IV) TXA in preventing blood loss in patients undergoing total hip and total knee arthroplasty.
Their findings were presented at the American Society of Regional Anesthesia and Pain Medicine’s recent 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting.
Previously available information suggested that oral, IV and topical TXA are all effective at reducing blood loss and drastically reducing blood transfusion rates during and after surgery, but research with direct comparisons for each method is limited.
“TXA in orthopedic surgery has become the standard of care. However, the most efficient, efficacious, and cost-effective method of administration remains unknown,” said principal investigator Stavros Memtsoudis, MD, PhD, MBA, an anesthesiologist at Hospital for Special Surgery.
“The oral administration of TXA 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 TXA 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 the standard of care.”
Dr. Memtsoudis and colleagues randomized 199 total hip and total knee arthroplasty patients between ages 18 and 80 to receive either oral TXA (1950 mg) 2 hours before surgery or IV TXA (1 gram) at the start of the procedure. The primary outcomes observed were blood loss and transfusion rates.
In patients who underwent total hip arthroplasty, the estimated blood loss calculated in the post-anesthesia care unit (PACU) for oral TXA was 534 ± 285 mL versus 676 ± 550 for IV TXA. On POD1, estimated blood loss was 769 ± 257 mL for oral TXA and 798 ± 302 ml for IV TXA.
In patients who underwent total knee arthroplasty, estimated blood loss in the PACU was 289 ± 219 mL for oral TXA and 486 ± 670 mL for IV TXA. On POD1, estimated blood loss was 716 ± 288 mL for oral TXA versus 846 ± 659 mL for IV TXA.
No patients received transfusions during surgery. One patient who received IV TXA required a transfusion after surgery.
“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,” Dr. Memstoudis said.
“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.”
Complete results of this study will be analyzed later this year.
Reichel JF, Popovic M, DeMeo D, Freeman C, Wong M, Zhong H, Liu J. Haskins SC, Kim DH, Jules-Elysee KM, Kirksey MA, Soffin EM, Maalouf DB, Garvin S, Beathe JC, DelPizzo K, Sideris A, Memtsoudis SG. The Effect of Oral Versus Intravenous Tranexamic Acid on Perioperative Blood Loss in Joint Arthroplasty Patients. Presented at the American Society of Regional Anesthesia and Pain Medicine’s 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, May 13-15, 2021, in Orlando, Florida.