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ANESTHETIC PHARMACOLOGY

The Postoperative Blood-Sparing Efficacy of Oral Versus Intravenous Tranexamic Acid After Total Knee Replacement

Edna Zohar, MD^*, Martin Ellis, MB BCh, Nisim Ifrach, MD^*, Avraham Stern, MD, Oleg Sapir, MD, and Brian Fredman, MB BCh^*

Departments of *Anesthesiology and Critical Care, Blood Bank, and Orthopedic Surgery, Meir Hospital, Kfar Saba, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Address correspondence and reprint requests to Brian Fredman, MB BCh, Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba 44281, Israel. Address e-mail to Fredman.Brian{at}clalit.org.il

To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min. Thereafter, a constant IV infusion of 10 mg · kg^–1 · h^–1 was administered until 12 h after final deflation of the limb tourniquet. In group TA-short, a similar regimen was followed; however, the constant IV infusion was discontinued 2 h after final deflation of the limb tourniquet (time of discharge from the postanesthesia care unit). Thereafter, oral TA 1 g was administered after 6 and 12 h. In group TA-oral, 60 min before surgery an oral dose of TA 1 g was administered. After surgery, a similar dose of TA was administered every 6 h for the next 18 h. In the control group, TA was not administered. At patient discharge, postoperative allogeneic blood administration was significantly more in group Control when compared with each of the three TA treatment groups. Because oral drug administration is simple and does not require specific infusion equipment, the authors suggest that oral TA is a superior blood-sparing strategy compared with IV drug administration.

IMPLICATIONS: To decrease complications related to blood transfusions, pharmacological manipulation of the clotting system may be performed. However, such strategies must be safe, reliable, and easy to administer. This study demonstrates that the blood-sparing efficacy of oral tranexamic acid is similar to that of IV tranexamic acid.

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