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EVALUATON OF EXTENDED POST-OPERATIVE ORAL TRANEXAMIC ACID AFTER TOTAL KNEE AND HIP ARTHROPLASTY
Thursday April 24, 2025 10:10am - 10:25am EDT
Olympia 2
EVALUATON OF EXTENDED POSTOPERATIVE ORAL TRANEXAMIC ACID AFTER TOTAL KNEE AND HIP ARTHROPLASTY 
Kayla Dodson, Alex Fagan, Shelby Hood, Sterling Torian
TriStar Centennial Medical Center – Nashville, TN
 
Background: Perioperative tranexamic acid has become the standard of care in total joint arthroplasty, aiming to reduce total blood loss and postoperative blood transfusions. Administered either intravenously and/or topically during surgery, tranexamic acid is believed to balance the fibrinolytic and procoagulant systems. Furthermore, its anti-inflammatory properties may offer additional benefits postoperatively for patients undergoing total knee arthroplasty, such as enhanced range of motion, commonly referred to as flexion. The use of extended courses of oral tranexamic acid postoperatively is an emerging therapy, though its clinical utility remains uncertain due to limited evidence regarding safety and efficacy. The purpose of this study was to evaluate the use of an extended course of postoperative oral tranexamic acid and establish a standardized protocol for its use in total knee and hip arthroplasty.
 
Methods: This was a single-center retrospective cohort study conducted through chart review from May 1, 2023 to July 1, 2024. Patients were identified based on the International Classification of Diseases-9 and International Classification of Diseases-10 codes for total knee or hip arthroplasty at admission. Patients who underwent elective knee or hip arthroplasty within the study timeframe were included. Exclusion criteria consisted of emergent or non-elective arthroplasty, documented religious preference that precludes use of blood products, tranexamic acid use on admission, end stage renal disease, and incarcerated patients. The primary outcome was the percentage reduction in hematocrit, calculated by subtracting the lowest postoperative hematocrit within 48 hours from the preoperative hematocrit. Secondary outcomes included the frequency of blood transfusions, flexion in total knee arthroplasty (TKA), and incidence of thrombotic complications. 
   
Results: A total of 229 patients were screened; 221 patients met inclusion criteria and 8 patients were excluded due to non-elective/emergent procedure. Baseline demographics were similar between groups. No significant difference was observed in reduction of hematocrit among those who received a course of extended postoperative oral tranexamic versus those who did not (mean difference -0.23; 95% CI (-1.27 – 0.8), p=0.660). The flexion degree of change in TKA was statistically significant in patients who did not receive oral TXA (mean difference 3.9; 95% CI (0.76 – 7), p=0.015). One patient developed a deep vein thrombosis in the non-oral TXA group. 
 
Conclusions: There was no observed difference in reduction of hematocrit in patients who received an extended course of postoperative oral tranexamic versus those who did not. There was also no difference in other clinically relevant outcomes including improved flexion in TKA, blood transfusion requirements and thrombotic complications. 
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Moderators
SB

Skyler Brown

University of Tennessee Medical Center: PGY2 Internal Medicine
Presenters
KD

Kayla Dodson

PGY1 Pharmacy Resident, TriStar Centennial Medical Center
Kayla completed her Doctor of Pharmacy at the University of Tennessee Health Science Center. Her interests include oncology, critical care and internal medicine. She will be pursuing a PGY-2 in Oncology with the University of Kansas Health System in July 2025.
Evaluators
avatar for Kristen Keen

Kristen Keen

PGY1 RPD, Harnett Health
Thursday April 24, 2025 10:10am - 10:25am EDT
Olympia 2
  Internal Medicine (IM), TriStar Centennial Medical Center
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