What oral medication is used post knee replacement surgery to prevent bleeding, specifically to manage postoperative hemorrhage?

From the Guidelines

Tranexamic acid is the primary oral medication used after knee replacement surgery to prevent bleeding and manage postoperative hemorrhage. According to the American College of Chest Physicians clinical practice guideline published in 2022 1, pro-hemostatic options include pre- and post-procedure administration of oral tranexamic acid. The guideline suggests administration of oral tranexamic acid mouthwash, two to three times daily, as part of the perioperative management of antithrombotic therapy.

Key points to consider when prescribing tranexamic acid for postoperative hemorrhage management include:

• The medication works by preventing the breakdown of blood clots, which helps control bleeding at the surgical site
• Patients should be informed of potential side effects, such as nausea, vomiting, or diarrhea
• Those with a history of blood clots, seizures, or kidney problems should be carefully evaluated before taking tranexamic acid
• It is essential to take the medication exactly as prescribed and to continue other recommended measures such as elevation, ice application, and gentle movement to further minimize bleeding and swelling after knee replacement surgery.

The use of tranexamic acid is supported by recent clinical practice guidelines 1, which prioritize its role in managing postoperative hemorrhage, thereby reducing morbidity, mortality, and improving quality of life for patients undergoing knee replacement surgery.

From the Research

Oral Medication for Preventing Bleeding Post Knee Replacement Surgery

• The oral medication used to prevent bleeding post knee replacement surgery is tranexamic acid (TXA) 2, 3, 4.
• TXA is an antifibrinolytic agent that has been shown to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA) 2, 3, 5, 4.
• The use of oral TXA has been compared to other antifibrinolytic agents, such as ε-aminocaproic acid, and has been found to be similarly effective in reducing blood loss 2.
• The dosage and administration schedule of TXA can vary, but common regimens include a single preoperative dose or multiple doses given pre- and postoperatively 3, 4.
• Studies have shown that TXA can be safely used in patients with a history of thromboembolic events, and that it does not increase the risk of thromboembolic complications 3, 4.

Comparison of TXA to Other Antifibrinolytic Agents

• A study comparing oral TXA to oral ε-aminocaproic acid found no significant differences in blood loss or transfusion rates between the two groups 2.
• Another study found that combined intravenous, topical, and oral TXA administration was effective in reducing blood loss and transfusion rates in patients undergoing TKA 3.

Safety and Efficacy of TXA

• TXA has been shown to be safe and effective in reducing blood loss and transfusion rates in patients undergoing TKA, with no significant increase in thromboembolic complications 3, 5, 4.
• A study found that TXA reduced postoperative bleeding without promoting thromboembolic events 5.
• Another study found that TXA appeared safe in patients with a history of thromboembolic, cardiovascular, and cerebrovascular disease 4.