In a TriNetX propensity-matched study of 5,722 total shoulder arthroplasty patients per group, oral TXA matched IV TXA on 90-day safety, transfusions, thromboembolic events, readmissions, ED visits, opioid use, and mortality. The retrospective cohort study also found no significant differences in postoperative hemoglobin, hematocrit, erythrocyte count, or platelet count, supporting oral TXA as an effective alternative to IV dosing in TSA.

Why It Matters To Your Practice

• You’re often the clinician making peri-op pathways actually work, and this study backs a practical option that does not appear to trade convenience for safety.

• For primary TSA, oral TXA performed comparably to IV TXA across major 90-day outcomes, giving your team more flexibility in pre-op and same-day workflows.

• That matters when you’re coordinating meds, patient education, discharge planning, and resource use across busy surgical services.

Clinical Benefits

• After matching, both groups had 5,722 patients, with no significant difference in transfusions at 90 days (P = 0.873).

• Thromboembolic outcomes were comparable, including DVT and PE, along with myocardial infarction, stroke, cardiac ischemia, acute renal failure, infection, wound issues, readmission, ED visits, opioid utilization, and mortality.

• Post-op lab profiles were also similar, with no significant differences in hemoglobin, erythrocyte count, hematocrit, or platelet count (all P > 0.14).

• Oral dosing may also reduce cost and simplify administration without compromising observed outcomes.

Managing Risks

• This was a Level III retrospective cohort study, so use the findings to inform practice—not replace patient-specific clinical judgment.

• Continue standard screening for thromboembolic risk, renal issues, cardiovascular history, and contraindications when selecting TXA route.

• Prospective studies are still needed on optimal oral dosing, which patients benefit most, and formal cost-effectiveness.

The Bottom Line

• For frontline NPs and PAs driving perioperative consistency, oral TXA looks like a credible, safe alternative to IV TXA in primary TSA.

• You’re not just carrying out the plan—you’re shaping safer, leaner surgical care, and this evidence supports using oral TXA when it fits the patient and the workflow.