Hemodynamics, fluids & transfusion
Evaluating Three Routes of Tranexamic Acid Administration in Total Hip and Knee Arthroplasty: A Nationwide Database Analysis in Taiwan
Authors' conclusion
TXA use was associated with substantial transfusion reduction without an overall increase in adverse events. No administration route or combination proved superior.
Study context
- Population
- Patients undergoing unilateral total hip or knee arthroplasty, Taiwan national health insurance database (2012 to 2021)
- Exposure
- Topical, IV and oral tranexamic acid (TXA) vs no TXA, and between routes
- Outcome
- Erythrocyte transfusion
Methodological detailsnationwide database, propensity score-matched comparisons, conditional logistic regression
- Nationwide database
- Propensity score-matched comparisons
- Conditional logistic regression
Main finding
As reported in the abstract
Relative risk (95% CI)P value
Topical vs No TXA
0.45(0.41–0.48)
P < 0.001IV vs No TXA
0.80(0.79–0.84)
P < 0.001Oral vs No TXA
0.82(0.73–0.92)
P = 0.007Topical vs IV
1.09(0.96–1.24)
P > 0.999Observational data: associations, not effects.
Further findings
Predicted transfusion risk, topical TXA at low dose (0 to 3.0 g)
- Greatest reduction in predicted transfusion risk
- −3,087 per 10,000 [−2,886, −3,276]
Safety
Venous thromboembolism (VTE), infections, wound complications · 60 days after discharge
- TXA use not associated with increased VTE, infections or wound complications overall
- Higher VTE incidence with topical TXA in patients with previous vascular disease without pharmacologic prophylaxis; not significant after adjustment
Renal injury · 60 days after discharge
- High-dose IV (>3.0 g) or oral (>8.0 g) TXA increased predicted risk in preexisting renal disease
- ≈10%
- Not associated overall
Original publication
Evaluating Three Routes of Tranexamic Acid Administration in Total Hip and Knee Arthroplasty: A Nationwide Database Analysis in Taiwan. Anesthesiology. Published 4 May 2026. doi:10.
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