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Oral tranexamic acid seen as efficacious, safe vs IV, topical forms for THA
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Results published in The Journal of Arthroplasty showed use of oral tranexamic acid during total hip arthroplasty was efficacious, safe and low cost compared with IV and topical tranexamic acid.
Researchers randomly assigned 180 patients undergoing total hip arthroplasty to receive tranexamic acid (TXA) either orally, through IV or topically. Researchers defined the primary outcome as the reduction in hemoglobin, and secondary outcomes included blood loss, transfusion rate, cost of TXA and adverse events.
Results showed no significant difference in mean reduction in hemoglobin level between the three groups. Researchers also found the three groups had no significant differences in total blood loss, transfusion rate, the number of units of packed red blood cells transfused and the length of hospital stay. Cost for TXA was lowest in the oral group at $70.56 compared with $489.40 in the IV group and $520.38 in the topical group. During the follow-up period, results showed no other adverse events, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke or acute renal failure. Results showed one patient in the oral group reported being neither satisfied nor dissatisfied. – by Casey Tingle
Disclosure s : The researchers report no relevant financial disclosures.
Perspective
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Yale A. Fillingham, MD
TXA has fundamentally changed blood management in TJA. As we have expanded our understanding of TXA efficacy, the question remains about the optimal TXA administration method. The current demand for cost-effective health care means the definition of “optimal” must include a treatment that achieves an effective outcome in a cost-conscious manner.
The study addresses this important question regarding optimal administration of TXA following THA. The authors’ elegant study design investigated administration of oral, IV or topical TXA in a randomized clinical trial. Like the recently presented clinical practice guidelines of American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society and American Society of Regional Anesthesia and Pain Medicine, the current study concludes equivalent blood-sparing properties for all methods of TXA administration.
In the study design, the authors appropriately powered the treatment groups to limit type II error. Additionally, the dose of oral TXA was given as 2 g approximately 2-hours prior to surgery. It’s important to note for individuals considering a transition to oral TXA, this dosing is necessary to achieve the drug’s therapeutic threshold.
In summary, the current study provides a valuable addition to our understanding regarding the effectiveness of the less costly, oral formulation of TXA.
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