Extended Oral Tranexamic Acid After Total Knee Arthroplasty

Phase 3

• Conditions: Osteo Arthritis Knee; Pain, Postoperative
• Interventions: Drug: Placebo; Drug: Tranexamic acid

• Registration Number: NCT06618820
• Lead Sponsor: Campbell Clinic

Brief Summary

The utilization of intraoperative tranexamic acid (TXA), whether administered intravenously or orally, has become a standard practice in total joint arthroplasty (TJA). Multiple studies have demonstrated the positive impact that TXA application has on clinical outcomes, including decreased blood loss and transfusion rates, decreased early swelling and ecchymosis, improved early recovery, and potentially superior long-term outcomes. Its ability to mitigate risk of blood loss made ambulatory total knee arthroplasty (TKA) safer for patients. The safety of intraoperative TXA use has also been documented. Sabbag et al. showed that TXA does not increase the risk of venous thromboembolism (VTE), even in those patients who are deemed high-risk. Multiple routes of TXA administration have been studied with each route demonstrating effectiveness in reducing blood loss. Findings showed that oral TXA is noninferior to intravenous TXA, though the median time to reach a target concentration is longer via the oral route and bioavailability is lower. With the benefits of intraoperative TXA clearly documented in literature, multiple centers investigated the utilization of extended TXA postoperatively in hopes of enhancing patient safety and reducing length of stay and healthcare cost. However, these studies reported conflicting outcomes and mostly focused on estimated blood loss, instead of patient reported outcomes.

The purpose of this study is to assess the effectiveness and safety of a varying extended oral TXA regimen during the postoperative period. Further, the investigators aim to determine the optimal duration of the TXA regimen to maximize its impact. The investigators hypothesize that an extended oral TXA regimen is safe and effective in improving clinical outcomes in TKA patients.

Detailed Description

Not available

Study Timeline

• Status Verified: 2024-09
• Study Start: 2024-09-17
• Study First Submitted: 2024-09-24
• Study First Submitted QC: 2024-09-25
• Last Update Submitted: 2024-09-25
• Study First Posted: 2024-10-01
• Last Update Posted: 2024-10-01
• Primary Completion: 2025-12
• Study Completion: 2026-09

Recruitment & Eligibility

• Status: ENROLLING_BY_INVITATION
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

1. 18 years of age and older.
2. Primary TKA at a Campbell Clinic Surgery Center, with implant at the discretion of the treating surgeon.
3. Willing to participate in the study.
4. Fluent in oral and written English.

Exclusion Criteria

1. Revision TKA.
2. Preoperative use of anticoagulants (81mg aspirin is allowed).
3. Prior history of deep vein thrombosis.
4. Prior history of cancer (with the exception of non-melanoma/metastatic skin cancers, low-grade non-metastatic benign soft tissue tumors, thyroid cancers and low grade, non-metastatic prostate cancers).
5. Known allergy or hypersensitivity to TXA.
6. Patients who are using combination hormonal contraception.
7. History of seizure disorder.
8. History of adult onset colorblindness.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Patients will receive 10 doses of microcrystalline cellulose (3 capsules per dose) from postoperative day (POD) 1 to POD 10.
3-day tranexamic acid (TXA)	Tranexamic acid	Patients will receive three 1950 milligram (mg) doses of Oral TXA (three 650mg capsules per dose) from POD 1 to POD 3 and 7 doses of Placebo from POD 4 to POD 10.
3-day tranexamic acid (TXA)	Placebo	Patients will receive three 1950 milligram (mg) doses of Oral TXA (three 650mg capsules per dose) from POD 1 to POD 3 and 7 doses of Placebo from POD 4 to POD 10.
10-day TXA	Tranexamic acid	Patients will receive ten 1950mg doses of Oral TXA (three 650mg capsules per dose) from POD 1 to POD 10.

Primary Outcome Measures

Name	Time	Method
Forgotten Joint Score - Knee	Enrollment; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	The Forgotten Joint Score measures how much the patient is aware of their affected knee during activities of daily living. A score of 0 indicates that the patient is always aware of their affected knee whereas a score of 100 indicates that the patient is not aware of their affected knee during activities of daily living.
Range of Motion	Enrollment; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	Passive flexion and extension range of motion of the surgical knee will be assessed with a goniometer in degrees.

Secondary Outcome Measures

Name	Time	Method
Knee Injury and Osteoarthritis Outcome Score for Joint Replacement	Enrollment; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	This questionnaire assesses patients' knee health with 0 representing total disability and 100 represents perfect knee health.
Patient-Reported Outcomes Measurement Information System	Enrollment; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	This questionnaire assesses patients' overall health and wellbeing with a T-score of 16.2 representing most severe physical impairment and a T-score of 67.7 represents best possible state of health.
Visual Analog Scale	Enrollment; postoperative day 1 to postoperative day 14; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	This questionnaire assesses patient's pain level with 0 being no pain at all and 10 being worst pain possible.
Opiate pill count	postoperative day 1 to postoperative day 14; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	The investigators will record the number of opiate medication taken by the patient and calculate morphine milligram equivalents.
Ambulatory aid	Enrollment; postoperative day 1 to postoperative day 14; 2-week postoperative; 6-week postoperative; 12-week postoperative; 1-year postoperative.	The investigators will record the use of ambulatory aid, such as walker.
Adverse Event	From signing consent form to completion of 1 year follow up visit.	The investigators will monitor for adverse events, including but not limited to deep venous thrombosis, and pulmonary embolism.

Trial Locations

Locations (1)

Campbell Clinic; 🇺🇸 Germantown, Tennessee, United States