A Comparison Of Oral Vs Intravenous Tranexamic Acid In Patients Undergoing Staggered Bilateral Total Knee Arthroplasty

Document Type : RESEARCH PAPER


1 Electricwala Hospital, Pleasant Park D Building, Pune, Maharashtra, India

2 Essence Medical Centre, Westwinds, Westwinds Dr. NE, Calgary, Alberta, Canada


Background: All previous studies comparing the blood sparing efficacy oral and intravenous tranexamic acid (TXA) in 
total knee arthroplasty have involved two or more patient cohorts, outcomes of which may be limited by inter-individual 
variability in human drug response. The purpose of this study was to evaluate if both oral and intravenous preparations 
of TXA are equivalent at reducing blood loss in the same patients undergoing staggered bilateral total knee arthroplasty.
Methods: 40 patients undergoing staggered bilateral total knee replacement were recruited. They received 2 g of oral 
TXA 2 hours preoperatively for the first knee and 1 g of bolus intravenous TXA 15 minutes before skin incision for the 
second knee. 7 patients were excluded for protocol deviation, leaving 33 participants for the study. The second knee 
was operated within 5-6 days of the first knee. The primary outcome was reduction in hemoglobin. Equivalence was 
tested with a two one-sided test (TOST) and a P < 0.05 indicated equivalence between oral and intravenous modes of 
TXA administration. 
Results: The mean reduction in hemoglobin was similar between oral and intravenous mode of TXA administration 
(2.18 and 2.16 g/dl respectively, P<0.0001, equivalence). There was no significant difference in the total hemoglobin 
loss and total red blood cell volume loss {(104 and 102 g, P=0.86) and (865 and 863 ml, P=0.53) respectively}. 
Conclusion: Oral and intra venous TXA have equal blood sparing properties in patients undergoing staggered bilateral 
total knee arthroplasty.
Level of evidence: II


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