The effect of oral versus intravenous tranexamic acid in reducing blood loss after primary total hip arthroplasty: A randomized clinical trial

Background: The purpose of this study was to determine whether the administration of multiple boluses of oral and intravenous tranexamic acid (TXA) postoperatively was equivalent in reducing blood loss in primary THA. Methods: A total of 108 patients were randomized into two groups: oral TXA group (54 patients receiving 1 dose of 20 mg/kg intravenous TXA 5-10 min before skin incision and 3 doses of 2 g oral TXA 4 h, 10 h and 16 h postoperatively) and intravenous TXA group (54 patients receiving 1 dose of 20 mg/kg intravenous TXA 5-10 min before skin incision and 3 doses of 1 g intravenous TXA 6 h, 12 h and 18 h postoperatively). The primary outcomes were total blood loss, hidden blood loss, length of hospital stay, hemoglobin (Hb) and hematocrit (Hct) drop. The secondary outcomes were the level of inflammation markers and complications. Results: There was no difference in the mean total blood loss or hidden blood loss [728.4 (645.8-806.9) mL vs 703.6 (576.9-832.8) mL, p=0.745; 634.6 (552.0-715.7) mL vs 606.4 (480.1-734.5) mL, p=0.710] and length of hospital stay was similar between the two groups. No patients received allogenic blood transfusion. The Hb and Hct drop on the first and second postoperative days were similar (p > 0.05). The level of inflammation markers did not reach statistical significance. The incidence of complications did not differ significantly between the two groups. Conclusions: Multiple boluses of oral TXA and intravenous TXA postoperatively are equivalent in reducing blood loss, Hb and Hct drop in primary THA without increasing the risk of thromboembolic diseases and wound complications.