Comparison of oral versus intravenous tranexamic acid in total knee and hip arthroplasty

Abstract

Supplemental Digital Content is available in the text

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…This means that approximately 1 red cell blood transfusion is given in the TXA group for every 3 transfusions in the placebo group. These results are comparable to newer meta-analyses [9,10,11]. There was no difference when comparing the different TXA administrations, but adding intra-articular TXA with IV yields a risk ratio of 0.08 (95 % CI 0.03;0.22) compared to placebo, an odds ratio of 0.32 (95 % CI 0.16;0.67) compared to only IV TXA, and an odds ratio of 0.13 (95 % CI 0.03;0.66) compared to only intra-articular TXA.…”

Hip and Knee Arthroplasty

“…Despite the publication of more than two thousand studies on TXA and outcomes after TJA, there is no consensus regarding the most effective and safest route, dose and timing of administration (Figure 1). Although all routes and formulations of TXA are effective, [19][20][21][22][23] emerging data support oral TXA as non-inferior to the intravenous route for minimizing bleeding, transfusion and infection, without increasing the risk of deep vein thrombosis. [22][23] Of particular relevance for value-based care, oral TXA is significantly less expensive than intravenous or topical formulations, and arguably easier for perioperative staff to access and administer.…”

“…Although all routes and formulations of TXA are effective, [19][20][21][22][23] emerging data support oral TXA as non-inferior to the intravenous route for minimizing bleeding, transfusion and infection, without increasing the risk of deep vein thrombosis. [22][23] Of particular relevance for value-based care, oral TXA is significantly less expensive than intravenous or topical formulations, and arguably easier for perioperative staff to access and administer. [22][23] These benefits would be expected to decrease direct and indirect costs of care (via reduced workload of perioperative personnel) and translate into cost-saving benefits for healthcare systems.…”

“…[22][23] Of particular relevance for value-based care, oral TXA is significantly less expensive than intravenous or topical formulations, and arguably easier for perioperative staff to access and administer. [22][23] These benefits would be expected to decrease direct and indirect costs of care (via reduced workload of perioperative personnel) and translate into cost-saving benefits for healthcare systems. Oral TXA may also represent a patient-safety advantage over intravenous formulations by eliminating inadvertent intrathecal administration, as has been described in case reports in patients undergoing spinal anesthesia for TJA.…”

“…• Reported doses range from 1-4 g, given 1-8 hours prior to surgery. [19][20][21][22][23] • The most common dose is 2g, given 2 hours prior to surgery. 19,23 • The optimal dose and timing are unclear, but a minimum dose of 2g is recommended.…”