TXA has fundamentally changed blood management in TJA. As we have expanded our understanding of TXA efficacy, the question remains about the optimal TXA administration method. The current demand for cost-effective health care means the definition of “optimal” must include a treatment that achieves an effective outcome in a cost-conscious manner.
The study addresses this important question regarding optimal administration of TXA following THA. The authors’ elegant study design investigated administration of oral, IV or topical TXA in a randomized clinical trial. Like the recently presented clinical practice guidelines of American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society and American Society of Regional Anesthesia and Pain Medicine, the current study concludes equivalent blood-sparing properties for all methods of TXA administration.
In the study design, the authors appropriately powered the treatment groups to limit type II error. Additionally, the dose of oral TXA was given as 2 g approximately 2-hours prior to surgery. It’s important to note for individuals considering a transition to oral TXA, this dosing is necessary to achieve the drug’s therapeutic threshold.
In summary, the current study provides a valuable addition to our understanding regarding the effectiveness of the less costly, oral formulation of TXA.
Yale A. Fillingham, MD
Adult reconstruction fellow
Disclosures: Fillingham reports no relevant financial disclosures.