title: Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement: results of 3000 procedures.
abstract: In our department we use an enhanced recovery protocol for joint replacement of the lower limb. This incorporates the use of intravenous tranexamic acid (IVTA; 15 mg/kg) at the induction of anaesthesia. Recently there was a national shortage of IVTA for 18 weeks; during this period all patients received an oral preparation of tranexamic acid (OTA; 25 mg/kg). This retrospective study compares the safety (surgical and medical complications) and efficacy (reduction of transfusion requirements) of OTA and IVTA. During the study period a total of 2698 patients received IVTA and 302 received OTA. After adjusting for a range of patient and surgical factors, the odds ratio (OR) of receiving a blood transfusion was significantly higher with IVTA than with OTA (OR 0.48 (95% confidence interval 0.26 to 0.89), p = 0.019), whereas the safety profile was similar, based on length of stay, rate of readmission, return to theatre, deep infection, stroke, gastrointestinal bleeding, myocardial infarction, pneumonia, deep-vein thrombosis and pulmonary embolism. The financial benefit of OTA is £2.04 for a 70 kg patient; this is amplified when the cost saving associated with significantly fewer blood transfusions is considered. Although the number of patients in the study is modest, this work supports the use of OTA, and we recommend that a randomised trial be undertaken to compare the different methods of administering tranexamic acid.
authors.affiliation: Northumbria Healthcare NHS Foundation Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington NE63 9JJ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Irwin
authors.forename: S K
authors.initials: SK
authors.lastname: Khan
authors.forename: S S
authors.initials: SS
authors.lastname: Jameson
authors.forename: R C
authors.initials: RC
authors.lastname: Tate
authors.forename: C
authors.initials: C
authors.lastname: Copeland
authors.forename: M R
authors.initials: MR
authors.lastname: Reed
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Blood transfusion; Enhanced recovery; Haemostatic concentration; Intravenous; Oral; Return to theatre; Tranexamic acid