Comparison of Oral versus Intravenous Tranexamic Acid in Total Hip and Knee Arthroplasty

Objectives: The aim of this study is to compare blood loss from IV (intravenous) TXA (tranexamic acid) to PO (oral) TXA in THA (total hip arthroplasty) and TKA (total knee arthroplasty) at UHSJMC (University Hospitals St. John Medical Center). The primary endpoint is to compare the hemoglobin change (g/dL) in patients using IV versus PO TXA after THA or TKA. The secondary endpoints are to compare the amount of blood loss (mL), amount of transfusions (units), and length of stay (days). Methodology: This is a retrospective chart review of patients who receive IV or PO TXA during a THA or TKA. Inclusion criteria are patients receiving IV TXA between September 1, 2018 and February 28, 2019 or patients receiving PO TXA between September 1, 2019 and February 29, 2020 for a THA or TKA. Patients will be excluded if they are less than 18 years old; patients who have a history of cognitive/psychosocial impairment, dementia, or language barrier, have had a deep vein thrombosis or pulmonary embolism within the past twelve months; have a history of deep vein thrombosis or pulmonary embolism being treated with anticoagulation; known congenital thrombophilia; or cardiac stent or ischemic stroke within one year. Primary endpoint will be analyzed using a standard independent T-test comparing mean change in hemoglobin. Secondary endpoints will be analyzed using descriptive statistics. Results: A total of 357 patients were reviewed for inclusion in the study with a total of 289 patients enrolled, 257 in the IV group and 32 in the PO group. There were 107 THA and 150 TKA included in the IV TXA group. There were 18 THA and 14 TKA included in the PO TXA group. The primary outcome of change in hemoglobin was -2.721 ± 1.04 g/dL for the IV TXA group and -2.513 ± 1.09 g/dL for the PO TXA group (p < 0.001). The secondary outcome of blood loss was 189.35 ± 180.2 mL for the IV TXA group and 89.69 ± 70.7 mL for the PO TXA group (p < 0.001). The secondary endpoint of length of stay was 2.02 ± 1.05 days for the IV TXA group and 1.84 ± 1.05 days for the PO TXA group (p < 0.001). Only one patient received a blood transfusion of 2 units during this study therefore statistical tests could not be performed. A post hoc analysis was preformed comparing THA to TKA. Hemoglobin change, length of stay, and transfusions were non-inferior to each other but amount of blood loss was significantly more for THA versus TKA (p < 0.001). Conclusion: With the ease of use of PO tablets, possible cost savings, and longer half-life, the use of PO TXA may be more beneficial for select patients. Future studies with larger sample sizes, randomization, and lack of surgeon variability are still needed.