Effects of Oral Tranexamic Acid Following Total Knee Arthroplasty

Phase 2

Recruiting

• Conditions: Postoperative Pain
• Interventions: Drug: Tranexamic acid

• Registration Number: NCT06479161
• Lead Sponsor: Matthew Grosso, MD

Brief Summary

The primary purpose of this study is to evaluate postoperative pain. Secondary outcomes evaluated in this study will include range of motion (ROM), opioid consumption, and ambulation. Each outcome measure will be evaluated, oral tranexamic acid (TXA) in the experiment arm and placebo in the control arm, after total knee arthroplasty (TKA) at postoperative days 0-3, and weeks 1, 2, 6, and 12.

Detailed Description

Randomized controlled trial with 1:1 allocation, selected through computer-based randomization.

This study will review prospectively collected data, including patient demographic information, surgeon, use of oral tranexamic acid (TXA) or placebo regimen, and postoperative outcomes up to 3 months after surgery. Collaboration with Saint Francis' pharmacy team will be performed to ensure appropriate blinded administering of the oral TXA and placebo medication.

This will be a double blinded study, with both patient and surgeon blinded to study group.

6.0 TXA dosing protocol TXA day of surgery \[All patients\]

* Administer 1-gram IV TXA intraoperatively at the start of the case (hold for history of stent within 1 year of surgery)

o AND

* Administer 1-gram IV TXA postoperatively before leaving PACU (hold for history of stent within 1 year of surgery)

o OR

* Exception: Administer 2 grams TXA in 50cc normal saline topically during the case for patients with a history of stent placed within one year of surgery.

TXA postoperative day (POD) 1-3 \[Experimental group\]

* Administer 1.95 grams oral (3- 650 mg tablets) TXA each morning for three days following surgery.

* Patients discharged home before POD 3 will be sent home with remaining oral TXA doses.

Placebo POD 1-3 \[Control group\]

* Administer oral placebo (3 tablets) each morning for three days following surgery.

* Patients discharged home before POD 3 will be sent home with remaining oral placebo doses.

Study Timeline

• Study Start: 2024-06-10
• Study First Submitted: 2024-06-20
• Study First Submitted QC: 2024-06-26
• Study First Posted: 2024-06-28
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-09
• Last Update Posted: 2024-12-13
• Primary Completion: 2025-02-28
• Study Completion: 2025-03-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• • All patients undergoing either manual or robotic primary total knee arthroplasty (TKA)
• Performed by participating Connecticut Joint Replacement Institute (CJRI) surgeons (Dr. Matthew Grosso, Dr. Robert McAllister, Dr. Chad Daniel, Dr. Eric Silverstein, Dr. Alex Dukas, Dr. Michael Joyce, Dr. Brett Wasserlauf).
• Male and female patient age 18-89
• Primary diagnosis of knee osteoarthritis

Exclusion Criteria

• Revision TKA

• No exclusion based on gender

• Patients <18 and >89 years old

• Exclusion for IV oral tranexamic acid (TXA):

  • TXA allergy - there are NO absolute contraindications for TXA use.
  • History of stent placed within one year of surgery - patient will receive topical TXA as an alternative.

• Exclusion for oral TXA:

  o Actively treated cancer or deep vein thrombosis (DVT)

• Chronic opioid use (opioid use within the 4 weeks prior to surgery)

• Allergies to nonsteroidal Anti-inflammatory drugs (NSAIDs) and acetaminophen

• Patients with clinically significant drug interactions

• Pre-existing neuropathy

• Current or previous venous thrombosis (DVT or venous stasis disease)

• Immuno-compromised secondary to medical condition

• Immune-suppressive medications, chemotherapy

• Pregnancy, breast feeding

• History of pain catastrophizing. Major depressive disorder

• History of suspected or known addiction to or abuse of illicit drug(s), prescription medicine(s), or alcohol within the past 2 years.

• Currently on a neuroleptic agent [e.g., gabapentin, pregabalin (Lyrica), duloxetine (Cymbalta) etc.].

• Non-English speaking and reading patient populations

• Any clinically significant event or condition uncovered during the surgery (e.g., excessive bleeding, acute sepsis) that, in the opinion of the investigator, renders the subject medically unstable or complicates the subject's post-operative course.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Tranexamic acid	- 3 tablets administered postop day one, postop day two and postop day three. Compounded by registered pharmacist and labeled with subject name and instructions for use.
TXA	Tranexamic acid	- 1.95 grams oral TXA (tranexamic acid) (3- 650 mg tablets) administered postop day one, postop day two and postop day three. Compounded by registered pharmacist and labeled with subject name and instructions for use.

Primary Outcome Measures

Name	Time	Method
Visual Analogue Scale (VAS) Pain scores	postoperative day (POD) 0, 1, 2, 3 (+/- 0 days) and weeks 1 (+/- 0 days), 2 (+/- 2 days), 6 and 12 (+/- 7 days).	Patient reported pain score from 0 to 10 where 0 is no pain and 10 is the most pain. Higher scores are a worse outcome.

Secondary Outcome Measures

Name	Time	Method
Range of Motion	at 2, 6 and 12 week follow up visits	Clinical measurement of passive, pain-free range of motion of knee in degrees from 0 to 180 from maximum extension to maximum flexion
Opioid consumption	POD 1, 2, 3 (+/- 0 days) and weeks 1 (+/- 0 days), 2 (+/- 2 days), 6 and 12 (+/- 7 days)	Subjects will keep a log recording opioid consumption. Research staff will ask subjects to report opioids during postoperative telephone calls.
Ambulation Status	at 2, 6 and 12 week follow up visits	Surgeon or physical therapist will record if patient is using a walker, cane or no assistive devices.

Trial Locations

Locations (1)

Trinity Health Of New England/CT Joint Replacement Institute; 🇺🇸 Hartford, Connecticut, United States