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Postoperative BleedingTXANCT06208267

Tranexamic Acid Use on Pain, Mobility and Bleeding Following Total Hip and Total Knee Arthroplasty

A study testing Tranexamic acid in people with Postoperative Bleeding, run by St. Mary's Research Center, Canada at 1 site in Canada.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Tranexamic acid (TXA) is an anti-fibrinolytic agent developed in the 1960s that has been safely used to reduce blood loss, transfusion rates and bleeding-associated mortality in trauma, obstetrics and orthopedic surgery, including hip fracture care and arthroplasty. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Postoperative Bleeding
What is being tested?
Tranexamic acid
Could I receive a placebo?
No, everyone receives an active treatment
How many people
210 participants
Where
1 siteCanada
Study dates
20 Aug 2025to Jul 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • ° All adults undergoing primary TKA and THA at St-Mary's Hospital

Who cannot join

  • Age < 18 years
  • Known hypersensitivity or allergy to TXA
  • Previous history of thromboembolic disease
  • Active malignancy (all current cancers other than local skin cancer)
  • Significant renal disease (hematuria, dialysis, kidney transplant)
  • History of convulsions
Show all 9Show fewer
  • Known defective colour vision
  • Inability or unwillingness to use MyMobility app
  • Unable to communicate in French or English

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Jennifer Mutch, MDCM, FRCSC contact

514 345 3511 ext. 3282

j.mutch.ortho@gmail.com

Sandhya Baskaran, MBA, M.ED contact

514 239 0042

sandhya.baskaran.comtl@ssss.gouv.qc.ca

Canada1 site, 1 recruiting
  • St. Mary's Hospital Center

    Montreal, Quebec, H3T 1M5

    Jennifer Mutch, MDCM, FRCSC, 514 345 3511 ext. 3282, j.mutch.ortho@gmail.com

    Sandhya Baskaran, MBA, M.ED, 514 239 0042, sandhya.baskaran.comtl@ssss.gouv.qc.ca

    Recruiting

Other trials in Canada

About this study

Official title: The Impact of Additional Post-operative Doses of Tranexamic Acid on Pain, Mobility and Bleeding Following Total Hip and Total Knee Arthroplasty: A Randomized Controlled Trial

Tranexamic acid (TXA) is an anti-fibrinolytic agent developed in the 1960s that has been safely used to reduce blood loss, transfusion rates and bleeding-associated mortality in trauma, obstetrics and orthopedic surgery, including hip fracture care and arthroplasty.

The efficacy and safety profile of TXA has been extensively studied in numerous clinical trials and observational studies. Its wide range of applications, combined with its favourable risk-benefit ratio, has led to the incorporation of TXA into clinical guidelines and protocols worldwide.

This RCT aims to compare the current standard dosing for TXA to additional TXA doses given orally post-operatively for THA and TKA patients. The goal is to compare the following between study groups: visible bleeding on post-operative dressing, mobilization (steps, amount of time moving around), pain (visual analog scale), function (Oxford hip and knee scales) and ROM at four to six weeks.

Read the detailed description

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are some of the most common surgical procedures performed in elderly patients, with the main indication being end-stage osteoarthritis. While these procedures can result in a significant amount of bleeding, pain and stiffness post-operatively, they have been increasingly performed as day surgeries and with reduced length of stay.

Tranexamic acid (TXA) is an anti-fibrinolytic agent developed in the 1960s that has been safely used to reduce blood loss, transfusion rates and bleeding-associated mortality in trauma, obstetrics and orthopedic surgery, including hip fracture care and arthroplasty.

The efficacy and safety profile of TXA has been extensively studied in numerous clinical trials and observational studies. Its wide range of applications, combined with its favourable risk-benefit ratio, has led to the incorporation of TXA into clinical guidelines and protocols worldwide.

The current standard of care at St-Mary's for TXA use is one gram given intravenously (IV) at the beginning of the replacement and one gram given during cementation. However, despite the established benefits of TXA, the optimal dosing regimen continues to be an area of ongoing research and discussion.

TXA and post-operative hemoglobin and hematocrit levels The use of TXA in knee and hip arthroplasty has been shown to have clear and significant benefits in reducing the post-operative drop in hemoglobin (Hb) and hematocrit (Hct) but the duration of use has ranged from a single pre-operative dose to a prolonged 14-day course. Researchers reported higher post-operative Hb and Hct following THA and TKA using a three-day course of TXA compared to a single pre-operative dose of 1.5g. However another study, showed no added benefit of the addition of a second post-operative dose to the single pre-operative dose. Similarly, an randomized controlled trial (RCT) comparing TXA doses at pre, during and three hours post-operative to the same with additional doses at six and 12 hours and showed no added benefit of the additional two doses on Hb or Hct levels. In contrast to this, three RCTs performed in 2019 and 2021 showed improved Hb and Hct levels with TXA use beyond a minimum of seven hours post-operatively and two involved the use of TXA given by mouth (PO), which is ideal in the ambulatory setting.

TXA and Ambulation/Motion The majority of the studies involving varying doses of TXA following THA and TKA have not assessed articular motion nor ambulation post-operatively. These can have an impact on patient satisfaction as well as the ability to mobilize and be able to leave the hospital earlier. TXA was compared to placebo and demonstrated that patients who received TXA ambulated 20% more during physiotherapy sessions. Several TXA regimens with patients receiving a minimum of three post-operative doses (maximum of four post-operative doses were studied),showed having significantly better range of motion (ROM) than patients who received less. Additionally, these patients reported less post-operative pain.

TXA and Complications

No increase in adverse events were reported in any of these studies following prolonged TXA use. Cardiovascular events, deep vein thrombosis (DVT), pulmonary embolism (PE), renal failure or superficial thrombosis were not different among study groups in the rare cases where they occurred, even with oral TXA given for up to 14 days post-operatively

. At St-Mary's Hospital, we perform a large number of TKAs and THAs, around 1100 per year (600 knees, 500 hips), making us the most productive hospital performing these procedures in Québec. Also, partly driven by the constraints of the pandemic over the past three years, we have successfully and safely reduced the length of stay for our patients and converted hundreds of patients to day surgery. Bleeding, however, remains a significant source of patient anxiety, with 10% of our ambulatory cases needing additional CLSC care or even return to hospital. Rapid mobilization and decrease in post- operative pain are also key factors for a rapid and safe discharge from hospital.

In this RCT, we aim to compare our current standard dosing for TXA to additional TXA doses given orally post-operatively for our THA and TKA patients. We will be the first of this type of study to assess patient mobility using a wearable device that will allow for precise measurement of step counts, amount of time moving around and sleep times. Also new compared to previous studies, will be our assessment of bleeding complications requiring intervention and needs for additional hospital or nursing visits, both of which have and impact on the cost of care. Pain (VAS scale), function (Oxford hip and knee scales) and ROM will also be assessed at 4-6 weeks.

Being tested
Tranexamic acid
Medical subject headings
Postoperative Hemorrhage

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Tranexamic acidDrug

    Also called CYKLOKAPRON

    This is a 3 arm RCT using the three dosage regimens mentioned above. Placebo doses will be provided for the 0, 8, 16 and 24 hours without TXA

Study groups in NCT06208267
Study groupRoleWhat they receive
1)Standard care: 1G TXA IVActive comparator1 gm TA IV given prior to incision and 1G TXA IV during cementation or closure
Receives: Drug: Tranexamic acid
2) Standard + 1G oral TXA - 0 and 8 hours post-operativelyActive comparatorStandard + 1G oral TXA given at 0 and 8 hours post-operatively
Receives: Drug: Tranexamic acid
3) Standard + 1G oral TXA given at 0, 8, 16 and 24 hours post-operativelyActive comparatorStandard + 1G oral TXA given at 0, 8, 16 and 24 hours post-operatively
Receives: Drug: Tranexamic acid

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Step counts at 24 and 48 hours post -operative

    We hypothesize that patients receiving additional doses of TXA will mobilize more at 24 and 48 hours post- operatively and that this will be dose-dependent.

    Measured: Post-operative

Secondary outcomes (11)
  1. Range of motion (ROM) of the hip (if applicable):

    Measuring ROM of the hip taken pre-operatively, post-operatively and 4 to 6 weeks post-operatively if patient received a total hip arthroplasty (THA)

    Measured: 4 - 6 weeks post op

  2. Range of motion (ROM) of the knee (if applicable):

    Measuring ROM of the knee taken pre-operatively, post-operatively and 4 to 6 weeks post-operatively if patient received a total knee arthroplasty (TKA).

    Measured: 4 - 6 weeks post op

  3. Patient self-assessment of functionality and pain measured pre-operatively, 4 to 6 weeks postoperatively, 3 months postoperatively and 6 months post-operatively following total hip arthroplasty utilizing the Oxford Hip Score (OHS):

    Minimal value of 0 and maximal value of 48. The higher scores indicate more satisfactory joint function.

    Measured: 4 to 6 weeks postoperatively, 3 months postoperatively and 6 months post-operatively

  4. Patient self-assessment of functionality and pain measured pre-operatively, 4 to 6 weeks postoperatively, 3 months postoperatively and 6 months post-operatively following total knee arthroplasty utilizing the Oxford Knee Score (OKS):

    joint function.

    Measured: 4 to 6 weeks postoperatively, 3 months postoperatively and 6 months post-operatively

  5. Bleeding Complications requiring intervention

    Bleeding that require a specific intervntion from CLSC/Clinic/Hospital visits

    Measured: Return to the emergency room or bleeding complications will be noted.

  6. Daily step counts

    To be measured with an application (MyMobility) on a smartphone or smartwatch used by the patient. This is a numerical value simply describing the number of steps taken by the patient on a day-to-day basis. This measurement will be collected pre-operatively (until OR), on post-operative day 0,1,2,3,5,7 and 4 to 6 weeks postoperatively.

    Measured: Post-operative day 0,1,2,3,5,7 and 4 to 6 weeks postoperatively.

  7. Measure of quality of life using the 12-Item Short Form Survey (SF-12):

    Regarding minimum and maximum values, there are two summary scores that are reported from the SF-12: there is a mental component score (MCS-12) and a physical component score (PCS-12). The scores may also be reported as Z-scores where a difference would be compared to the population average.

    In the literature, SF-12 results have also been computed as a range going from a minimum value of 0 to a maximum value of 100, where higher scores indicate better physical and mental health functioning.

    Measured: This measurement will be taken pre-operatively, 4 to 6 weeks postoperatively, 3 months postoperatively and 6 months post-operatively.

  8. Assessment and screening for depression and anxiety in patients utilizing the Hospital Anxiety Depression Scale (HADS) :

    Minimum score of 0 and maximum score of 21. The higher scores indicate higher distress.

    Measured: Pre-operative

  9. Reported pain self-reported in patient journal and possibly in-patient charts:

    This is a numerical value. Patient journals and/or in-patient charts, if applicable, would be screened for frequency of opioid use as a way of evaluating pain management post-operatively.

    Measured: These journals and/or in-patient charts will be verified on postoperative day 0,1,2,3,5 and 7.

  10. Assessment of catastrophic thinking related to pain utilizing the Pain Catastrophizing Scale (PCS):

    Minimum score of 0 and maximum score of 52. The higher scores indicate higher levels of catastrophizing.

    Measured: Pre-operative

  11. Reported pain using the visual analog pain (VAS) scale:

    The pain VAS scale involves a numerical rating scale or a descriptive rating scale that progressively goes from a minimal value indicating severe pain to a maximal value indicating good pain management.

    Measured: This measurement will be collected on postoperative day 0, 1,2,3,5 and 7.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Jan 2024
  2. Study start20 Aug 2025
  3. Primary completionApr 2027 (estimated)
  4. Study completionJul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
210 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06208267
Sponsor's protocol ID
2024-1082
Acronym
TXA
Status last verified
Apr 2026
First submitted
2 Nov 2023
Last updated
28 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Tranexamic acid in people with Postoperative Bleeding, run by St. Mary's Research Center, Canada at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jennifer Mutch, MDCM, FRCSC (514 345 3511 ext. 3282, j.mutch.ortho@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Step counts at 24 and 48 hours post -operative (time frame: Post-operative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Apr 2026.

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