Oral vs. Intravenous TXA Study Proposal: TJA

Purpose: Examine oral and intravenous Tranexamic Acid (TXA) to determine whether or not the different routes of drug administration are equivalent in terms of post-operative reduction in hemoglobin, number of transfusions, and post-operative blood loss following TJA surgery.

Hypothesis: Oral and intravenous TXA are equivalent routes of drug administration.

Background/Scientific review:

Total hip or knee arthroplasty is associated with the risk of moderate to significant blood loss. Techniques such as the use of antifibrinolytics or desmopressin, or normovolaemic haemodilution have been used to reduce the need for allogeneic blood transfusion. Tranexamic acid (TXA) has been used to reduce blood loss and transfusion requirement for total hip and knee arthroplasty, with good results. Approximately one-third of patients undergoing total joint replacement surgery require one to three units of blood postoperatively. Tranexamic acid is a synthetic antifibrinolytic agent that has been successfully used intravenously to control bleeding after total joint replacement. The use of TXA has been shown to significantly reduce the need for blood products during total joint replacement1-4.

There are only a few studies directly comparing outcomes following the use of intravenous tranexamic acid (IVTA) and oral tranexamic acid (OTA) in arthroplasty surgery. In the randomized study by Zohar et al5. OTA (n = 20) was associated with significant allogeneic blood sparing com- pared with controls (n = 20), but not when compared with short- and long-term IVTA regimens. A recent randomized trial comparing OTA (n = 26) with placebo (n = 20) reported significant reductions in blood drained at 24 hours, and in the fall of both Hb and Hct in the OTA group, without any significant difference in the requirement of transfusion6.