Oral tranexamic acid is non-inferior to a more expensive topical/IV/oral combination in the prevention of blood loss with total knee arthroplasty.

A small Queensland study comparing the two regimens in 53 patients at a single centre found no difference in efficacy or safety outcomes between the two treatment options.

Patients in the oral-only treatment group received three 1 g doses of tranexamic acid – two hours before surgery and then two and six hours after surgery. The other patients received the standard care at the hospital, which was 3 g topical tranexamic acid during surgery, 1g IV at two hours post-op and 1g oral at six hours.

The study found the mean haemoglobin change between pre-op and one day post-op samples was not significantly different between the two treatment groups (32.9 v 31.8 g/L).

Measured blood loss (during surgery and in a drain for the first day post-op) was also not significantly different between the patient groups (640 v 528 ml). Calculated total blood loss using the Meunier’s formula was also similar in both groups (1211 v 1092 ml).

No patients in the oral only treatment group and one patient in the standard care group required a blood transfusion. Length of hospital stay was also similar (4.0 v 4.5 days).

There were no DVTs reported in either group and no significant difference in potential adverse effects between the groups.

The researchers, from Griffith University and the John Flynn Hospital on the Gold Coast, said their study was the first to directly compare oral-only to a combined topical/IV/oral regimen.

Despite its limitations including a small sample size, they said the study showed the switch to oral-only tranexamic acid did not impact patient outcomes.

“The benefits of demonstrating non-inferiority of the oral regime compared to the combined topical/IV/oral regime are two-fold. Firstly, it results in significant cost savings to the healthcare facilities and healthcare providers with the IV formulation almost 40-fold more expensive than the equivalent oral dose.

“Secondly, replacing the combined TXA regime with an oral regime can reduce the burden on nursing staff,” they said.

Knee surgeon Dr Chris Vertullo, who was not associated with the study, told the limbic tranexamic acid has been one of the biggest changes in arthroplasty in the last decade leading to less pain, faster recovery and fewer transfusions.

While oral tranexamic acid was definitely much cheaper than IV – about seven cents a tablet versus $25 a vial – he said all forms of the drug were inexpensive compared to the costs of blood transfusion and longer hospital stays if it wasn’t used.

He added there was huge variation in the way it was administered across different hospitals and surgeons.