Comparison between Oral and Intravenous Tranexamic Acid in Total Hip and Knee Arthroplasty

Introduction: Total hip and knee arthroplasty is associated with significant perioperative blood loss, increasing the risk of anemia, transfusion, and prolonged hospitalization. Tranexamic acid (TXA) is widely used to minimize surgical bleeding, but the optimal route of administration remains under debate, particularly between oral and intravenous forms. Objective: To compare the efficacy of oral versus intravenous tranexamic acid regarding total blood loss and length of hospital stay in patients undergoing total hip and knee arthroplasty. Methods: This is a narrative literature review. The search was conducted in the PubMed/MEDLINE and SciELO databases using the descriptors “acid tranexamic,” “intravenous,” “oral,” and “total knee/hip arthroplasty,” combined with the Boolean operators AND and OR. Randomized clinical trials and meta-analyses published in Portuguese, English, or Spanish from 2020 onwards that directly compared oral and intravenous TXA in total arthroplasty were included. Results: The findings indicate that oral and intravenous TXA have equivalent efficacy in reducing total blood loss. No significant differences were observed in hospital stay duration or complication rates between the administration routes. The oral route demonstrated logistical advantages and lower cost. Conclusion: Oral tranexamic acid is as effective and safe as the intravenous route in hip and knee arthroplasty, representing a viable, accessible alternative with potential to reduce hospital costs.