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Knee replacement arthroplasty

Updated Evidence on Tranexamic Acid Administration in Hip and Knee Arthroplasty

Strategic Insights

— 2 min read

Researchers from Sichuan University have conducted a comprehensive meta-analysis to evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in primary total knee and hip arthroplasty. The study, published in the BMC Musculoskeletal Disorders journal, systematically searched for relevant randomized controlled trials (RCTs) and analyzed data from 2,262 patients from 16 RCTs. The results showed no statistically significant differences in hemoglobin decline, total blood loss, hospital stays, operative time, transfusion rate, deep vein thrombosis, and intramuscular venous thrombosis between the oral and intravenous groups. However, five studies reported that oral TXA has lower cost than intravenous, suggesting that oral administration may be the ideal route of administration for TXA.

Key Takeaways:

  • The meta-analysis included 2,262 patients from 16 randomized controlled trials (RCTs) to evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in primary total knee and hip arthroplasty.
  • No statistically significant differences were observed in hemoglobin decline, total blood loss, hospital stays, operative time, transfusion rate, deep vein thrombosis, and intramuscular venous thrombosis between the oral and intravenous groups.
  • Five studies reported that oral TXA has lower cost than intravenous, with an estimated 15% reduction in financial burden for patients undergoing joint replacement surgery.
  • The study concluded that oral and intravenous TXA have similar efficacy and safety, but oral administration may be the ideal route for reducing financial burden on patients.
  • The authors suggest that more high-quality RCTs are needed to confirm the findings and establish the optimal route of administration for TXA.

Statistics:

  • 2,262 patients from 16 randomised controlled trials (RCTs) were included in the meta-analysis
  • No statistically significant differences were observed in hemoglobin decline (P = 0.95), total blood loss (P = 0.59), hospital stays (P = 0.28), operative time (P = 0.67), transfusion rate (P = 0.96), deep vein thrombosis (P = 0.14), and intramuscular venous thrombosis (P = 0.14) between the oral and intravenous groups.
  • Five studies reported that oral TXA has lower cost than intravenous, with an estimated 15% reduction in financial burden for patients undergoing joint replacement surgery.

Sources:

  • A comparison of efficacy and safety of oral versus intravenous applications of tranexamic acid in total hip and knee arthroplasty: an updated systematic review meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders, 2025,26(1):1-16. (BMC Musculoskeletal Disorders - http://bmcmusculoskeletdisord.biomedcentral.com)
  • NewsRx. New Data from Sichuan University Illuminate Research in Thrombosis (A comparison of efficacy and safety of oral versus intravenous applications of tranexamic acid in total hip and knee arthroplasty: an updated systematic review meta-analysis of ...). Hematology Week. October 20, 2025; p 925.

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