medigraphic.com
ISSN 2007-8560 (Print)
Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2024, Number 4

<< Back Next >>

Ortho-tips 2024; 20 (4)

Efficacy and economic considerations of oral versus intravenous tranexamic acid in reducing postoperative blood loss in total hip and knee arthroplasty: an ambispective study in a low socioeconomic population

Vallejo GEE, Bobadilla LG, Martínez EFA, Balam MÁJ, Oropeza BF, Cámara AF

Language: Spanish
References: 17
Page: 221-227
PDF size: 266.63 Kb.


ABSTRACT

Introduction: tranexamic acid (TXA) is recognized for its efficacy in reducing blood loss in hip and knee arthroplasties. There is an ongoing debate about the optimal method of administration. Objective: to evaluate the efficacy and economic impact of oral versus intravenous tranexamic acid in reducing postoperative hemoglobin loss in patients of low socioeconomic status. Material and methods: this observational, descriptive, and ambispective study was conducted in Mérida, Yucatán, between May 2022 and June 2023. Patients scheduled for hip or knee arthroplasty were randomly assigned to three groups: intravenous tranexamic acid (1 g in 100 ml of NaCl), oral tranexamic acid (1,950 mg), and a control group without tranexamic acid. Results: the intravenous group recorded the lowest postoperative blood loss (229.302 ml) and hemoglobin decrease (2.48 g/dl). The oral group showed a blood loss of 303.125 ml and a decrease in hemoglobin of 2,022 g/dl, while the control group had the highest values with 421.429 ml and 3,621 g/dl, respectively. The cost of oral treatment was $7.82 USD compared to $98.77 USD for intravenous administration. Conclusion: both oral and intravenous tranexamic acid are effective in reducing blood loss in hip and knee arthroplasty. Oral administration of tranexamic acid emerges as a cost-effective alternative, especially relevant for patients of low socioeconomic status.


REFERENCES

  1. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010; 113 (2): 482-495.

  2. Kim JL, Park JH, Han SB, Cho IY, Jang KM. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: a meta-analysis. J Arthroplasty. 2017; 32 (1): 320-325.

  3. Hiippala S, Strid L, Wennerstrand M, Arvela V, Mantyla S, Ylinen J, Niemelä H. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995; 74 (5): 534-537.

  4. Cai J, Ribkoff J, Olson S, Raghunathan V, Al-Samkari H, DeLoughery TG, et al. The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020; 104 (2): 79-87.

  5. Grassin-Delyle S, Semeraro M, Lamy E, Urien S, Runge I, Foissac F, et al.. Pharmacokinetics of tranexamic acid after intravenous, intramuscular, and oral routes: a prospective, randomised, crossover trial in healthy volunteers. Br J Anaesth. 2022; 128 (3): 465-472.

  6. Melvin JS, Stryker LS, Sierra RJ. Tranexamic acid in hip and knee arthroplasty. J Am Acad Orthop Surg. 2015; 23 (12): 732-740.

  7. Luo ZY, Wang HY, Wang D, Zhou K, Pei FX, Zhou ZK. Oral vs intravenous vs topical tranexamic acid in primary hip arthroplasty: a prospective, randomized, double-blind, controlled study. J Arthroplasty. 2018; 33 (3): 786-793.

  8. Ye W, Liu Y, Liu WF, Li XL, Fei Y, Gao X. Comparison of efficacy and safety between oral and intravenous administration of tranexamic acid for primary total knee/hip replacement: a meta-analysis of randomized controlled trial. J Orthop Surg Res. 2020; 15 (1): 21.

  9. Fillingham YA, Kayupov E, Plummer DR, Moric M, Gerlinger TL, Della Valle CJ. The James A. Rand young investigator's award: a randomized controlled trial of oral and intravenous tranexamic acid in total knee arthroplasty: the same efficacy at lower cost? J Arthroplasty. 2016; 31 (9 Suppl): 26-30.

  10. Chen X, Zheng F, Zheng Z, Wu X, Wu C. Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore). 2019; 98 (20): e15248.

  11. Irwin A, Khan SK, Jameson SS, Tate RC, Copeland C, Reed MR. Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement: results of 3000 procedures. Bone Joint J. 2013; 95-B (11): 1556-1561.

  12. King L, Randle R, Dare W, Bernaitis N. Comparison of oral vs. combined topical/intravenous/oral tranexamic acid in the prevention of blood loss in total knee arthroplasty: a randomised clinical trial. Orthop Traumatol Surg Res. 2019; 105 (6): 1073-1077.

  13. Wu Y, Zeng Y, Hu Q, Li M, Bao X, Zhong J, et al. Blood loss and cost-effectiveness of oral vs intravenous tranexamic acid in primary total hip arthroplasty: a randomized clinical trial. Thromb Res. 2018; 171: 143-148.

  14. Wang D, Wang HY, Luo ZY, Pei FX, Zhou ZK, Zeng WN. Finding the optimal regimen for oral tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2019; 101 (5): 438-445.

  15. Shah N, Khetan V, Sivanadan H. Should tranexamic acid be used for 3 days after total knee replacement? A randomized study in 250 patients. Acta Orthop Belg. 2021; 87 (4): 697-703.

  16. Kayupov E, Fillingham YA, Okroj K, Plummer DR, Moric M, Gerlinger TL, Della Valle CJ. Oral and intravenous tranexamic acid are equivalent at reducing blood loss following total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2017; 99 (5): 373-378.

  17. Sun Q, Li J, Chen J, Zheng C, Liu C, Jia Y. Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials. BMJ Open. 2019; 9 (1): e024350.



EVIDENCE LEVEL

III A




2020     |     www.medigraphic.com