Background and Aims The use of tranexamic acid (TXA) has reduced rates of perioperative blood transfusion for total hip arthroplasty (THA) and total knee arthroplasty (TKA)¹. While oral rather than intravenous (IV) dosing of TXA at the time of surgery may simplify perioperative protocols and reduce costs, it is not clear whether oral TXA is as effective as IV TXA in reducing blood loss and transfusion rates.

Methods This randomized controlled trial compared the use of one preoperative dose of oral TXA (1,950mg) to one preoperative dose of IV TXA (1,000mg) in THA (N=200) and TKA (N=200). Consecutive patients undergoing primary THA or TKA under regional anesthesia with sedation were enrolled. The primary outcome was calculated blood loss (CBL). Secondary outcomes were transfusions and complications, including cardiac events and venous thromboembolism. The study was designed as a non-inferiority trial with an intention-to-treat analysis.

Results Oral TXA was non-inferior to IV TXA (p<0.001). Mean CBL values were 842.21 mL versus 860.45 mL for THA and 798.48 mL versus 878.13 mL for TKA in the oral and IV arms, respectively. There was one postoperative transfusion, which occurred in the IV TXA arm of the study. There was no difference in complication rates between the two arms of the study.

Conclusions Oral TXA can be feasibly administered in the preoperative setting prior to THA or TKA and is non-inferior to IV TXA with respect to CBL and transfusion rates in this setting.