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Interim Study Results Suggest Oral Tranexamic Acid (TXA) Is Equally Effective as Intravenous TXA in Preventing Blood Loss in Joint Replacement Surgery

Interim results of a study conducted by researchers at Hospital for Special Surgery (HSS) suggest that oral tranexamic acid (TXA) is non-inferior to intravenous (IV) TXA in preventing blood loss in total knee and total hip replacement surgery. These findings were presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.1

Previously available information suggests that oral, IV and topical TXA are all effective at reducing blood loss and drastically reducing blood transfusion rates during and after surgery, but research with direct comparisons for each method is limited.

“TXA in orthopedic surgery has become the standard of care. However, the most efficient, efficacious and cost effective method of administration remains unknown,” said principal investigator Stavros Memtsoudis, MD, PhD, MBA, an anesthesiologist at HSS. “The oral administration of TXA is logistically easier, thus reducing the risk of drug errors in the OR. It is also less costly. We are performing this study to identify if oral TXA is also equally efficacious at preventing blood loss. If this is the case, oral administration of the drug preoperatively as a one-time dose could become the standard of care.”

Dr. Memtsoudis and colleagues randomized 199 patients between ages 18 and 80 undergoing total hip or total knee replacement to receive either oral TXA (1950 mg) two hours before surgery or IV TXA (1 g) at the start of the procedure. The primary outcomes observed were blood loss and transfusion rates.

In patients who underwent total hip replacement, the estimated blood loss calculated in the post anesthesia care unit (PACU) for oral TXA was 534 ± 285 mL, versus 676 ± 550 for IV TXA. On postoperative day one, estimated blood loss was 769 ± 257 mL for oral TXA and 798 ± 302 ml for IV TXA.

In patients who underwent total knee replacement, estimated blood loss in the PACU was 289 ± 219 mL for oral TXA, and was 486 ± 670 mL for IV TXA. On postoperative day one, estimated blood loss was 716 ± 288 mL for oral TXA versus 846 ± 659 mL for IV TXA.

No patients received transfusions during surgery. One patient who received IV TXA received a transfusion after surgery.

“Given our interim results, it seems that the oral version of TXA is equally as effective as intravenous administration. This translates to improvements in efficiency, cost and safety, all of which are important for patients, clinicians and policy makers,” Dr. Memstoudis said. “The research seems rather clear at this point. However, a uniform translation into policy is what is needed, as there seems to be limited translation of best evidence into practice.”

Complete results of this study will be analyzed later this year.


1. Julia F. Reichel, BA, Marko Popovic, BS, Danya DeMeo, BS, Carrie Freeman, BS, Marisa Wong, BA, Haoyan Zhong, MPA, Jiabin Liu, MD, PhD, Stephen C. Haskins, MD, David H. Kim, MD, Kethy M. Jules-Elysee, MD, Meghan A. Kirksey, MD, PhD, Ellen M. Soffin, MD, PhD, Daniel B. Maalouf, MD, MPH, Sean Garvin, MD, Jonathan C. Beathe, MD, Kathryn DelPizzo, MD, Alexandra Sideris, PhD, Stavros G. Memtsoudis, MD, PhD, MBA. “The Effect of Oral Versus Intravenous Tranexamic Acid on Perioperative Blood Loss in Joint Arthroplasty Patients.” Presented at: 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), May 13-15, 2021; Orlando, FL.

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.