Extended Oral Tranexamic Acid After Primary Total Knee Arthroplasty

Inclusion Criteria: * Patients are candidates for elective primary total knee arthroplasty. * Patients ≥18 years of age * Patients have been medically evaluated and scheduled for primary total knee arthroplasty. * Patients undergo primary total knee arthroplasty with spinal anesthesia * Patients receive 1g IV TXA prior to incision and 1g IV TXA at closure * Patients are prescribed aspirin 81mg twice a day for postoperative VTE prophylaxis Exclusion Criteria: * Patients with an allergy to TXA * Patients taking a preoperative anticoagulant other than aspirin * Patients with a history of VTE * Patients with chronic kidney disease * Patients with active malignancy * Current use of combined hormonal contraception (pill, patch, or ring) * eGFR \<60 mL/min/1.73 m² or other clinically significant renal impairment * Use of Factor IX complex concentrates, anti-inhibitor coagulant concentrates, or all-trans retinoic acid (tretinoin) * Anticipated need for tissue plasminogen activator (tPA) during the 7-day dosing period * Individuals who are pregnant or breastfeeding, have a positive pre operative pregnancy test, or plan pregnancy during the 7 day dosing window. Women of childbearing potential must have a negative pre operative pregnancy test and use effective contraception through postoperative day . Individuals who are on hormonal contraceptives or hormone replacement therapies, with the exception of Progestin, are to be excluded.