Oral TXA as effective and safe as IV TXA in hip and knee arthroplasty: study

Dr Supreeth  D R

Oral TXA as effective and safe as IV TXA in hip and knee arthroplasty: study

Written By : Dr Supreeth D R Published On 2025-10-26T21:15:25+05:30 | Updated On 26 Oct 2025 9:15 PM IST

Oral TXA is as effective and safe as IV TXA in patients undergoing hip and knee arthroplasty: study

Tranexamic acid (TXA) has been extensively used in total hip and total knee arthroplasty (THA and TKA) to reduce blood loss. The commonly investigated routes of TXA administration include oral, intravenous, intra-articular, and topical methods. However, the ideal route of administration remains controversial. Feng et al conducted a study to evaluate and compare the efficacy and safety of oral versus intravenous tranexamic acid in primary total knee and hip arthroplasty.

The PubMed, Web of Science, Cochrane Library and Embase databases were systematically searched for relevant randomized controlled trials (RCTs). Decline of hemoglobin (DHB), total blood loss (TBL), length of hospital stays (HS), intra-operative blood loss (IBL), operative time, transfusion rate, deep vein thrombosis (DVT) and intramuscular venous thrombosis (IVT) were extracted and analyzed. Sensitivity analyses were conducted for each outcome based on the degree of heterogeneity. Furthermore, we assessed publication bias through funnel plots, Egger tests and the trim-and-fill method. The study adhered to PRISMA and AMSTAR guidelines. All of the analyses were performed using Review Manager (RevMan) 5.4 and Stata 15.0 software.

The key findings of the study were:

• A total of 2,262 patients from 16 randomized controlled trials (RCTs) were ultimately included in the meta-analysis.

• No statistically significant differences were observed in terms of decline of hemoglobin (P = 0.95), total blood loss (P = 0.59), length of hospital stays (P = 0.28), intra-operative blood loss (P = 0.64), operative time (P = 0.67), transfusion rate (P = 0.96), deep vein thrombosis (P = 0.14), intramuscular venous thrombosis (P = 0.14) between the oral and intravenous groups.

• Five studies reported that oral TXA has lower cost than intravenous.

The authors concluded – “This meta-analysis of high-quality RCTs provides robust evidence that oral TXA is as effective and safe as IV TXA for reducing perioperative blood loss, hemoglobin (Hb) drop, transfusion rates, length of hospital stays, intra-operative blood loss, operative time, DVT and IVT in patients undergoing THA and TKA. Additionally, oral TXA offers significant cost advantages and simplifies perioperative management, making it an attractive alternative to IV TXA in clinical practice.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.