The Postoperative Blood-Sparing Efficacy of Oral Versus Intravenous Tranexamic Acid After Total Knee Replacement

Abstract

To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min. Thereafter, a constant IV infusion of 10 mg . kg(-1) . h(-1) was administered until 12 h after final deflation of the limb tourniquet. In group TA-short, a similar regimen was followed; however, the constant IV infusion was discontinued 2 h after final deflation of the limb tourniquet (time of discharge from the postanesthesia care unit). Thereafter, oral TA 1 g was administered after 6 and 12 h. In group TA-oral, 60 min before surgery an oral dose of TA 1 g was administered. After surgery, a similar dose of TA was administered every 6 h for the next 18 h. In the control group, TA was not administered. At patient discharge, postoperative allogeneic blood administration was significantly more in group Control when compared with each of the three TA treatment groups. Because oral drug administration is simple and does not require specific infusion equipment, the authors suggest that oral TA is a superior blood-sparing strategy compared with IV drug administration.

Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

“…Zohar et al (27) implants (30)(31)(32)(33) and favored based on the concern that systematic administration of IV-TXA might potentially increase the risk of thrombosis (34). In contrast, the TEG data obtained in the current study suggest that IV-TXA did not promote hypercoagulation since the mean CI in the TXA and FS + TXA groups was less than +3 and this CI remained similar to that of the control group during hospitalization.…”

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

“…Similar to their hemoglobin findings, both Irwin and Fillingham found comparable transfusion rates (<10%) between IV and oral TXA. Zohar, one of the first authors to study oral TXA in total joint surgery found a significant decrease in transfusion rates between placebo and oral TXA groups and Bradshaw's prospective study of oral TXA in total knee arthroplasty found no transfusions in the TXA group [33,35]. The literature remains somewhat unclear however.…”

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

“…14 Oral TXA has been shown to decrease blood loss 2 and has similar efficiency as IV administration. 15 As the oral form of TXA is cheaper than the IV form, the financial benefit of oral TXA application has been reported as £2.04 (GB sterling) per patient. 16 Beside the relatively low cost of oral TXA, the simple application avoiding IV access is a further advantage reducing additional costs and avoiding expensive nursing care for IV application.…”