Comparison of Oral and Intravenous Tranexamic Acid for Prevention of Perioperative Blood Loss in Total Knee and Total Hip Arthroplasty

Abstract

Background: Tranexamic acid (TA) is an antifibrinolytic agent that prevents perioperative blood loss in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). This benefit has been established with the intravenous (IV) dosage form, but there is limited evidence evaluating oral TA in this setting. Objective: To compare the effect of oral versus IV TA on perioperative blood loss in those undergoing TKA or THA. Methods: In this single-centered retrospective chart review, participants at least 18 years of age who received IV or oral TA from a single surgeon who performed their THA or TKA were included. The primary outcome evaluated hemoglobin (Hgb) reduction. Power analysis determined that 165 participants were required in each group to achieve 80% power, with a noninferiority margin of 0.3 mg/dL. Results: Both study groups included 165 participants. Oral TA was noninferior to IV TA (Hgb difference = −0.12 g/dL [95% CI = −0.28 to 0.05; P = 0.0250]). A subgroup analysis of THA and TKA revealed that oral TA was noninferior to IV TA in THA (Hgb difference = 0.24 g/dL [95% CI = −0.17 to 0.5]), but oral TA failed to meet the noninferiority margin in the TKA subgroup (Hgb difference = −0.20 [95% CI = −0.38 to −0.02]). Conclusion: This study provides evidence that oral TA is a clinically effective and cost-efficient alternative to IV TA in the setting of THA and TKA.