Efficacy of Local Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing Intertrochanteric Fracture Surgery

Drakos, Athanasios; Raoulis, Vasileios; Karatzios, Konstantinos; Doxariotis, Nikolaos; Kontogeorgakos, Vasileios; Malizos, Konstantinos N.; Varitimidis, Sokratis

doi:10.1097/bot.0000000000000577

Cited by 66 publications

(74 citation statements)

References 40 publications

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“…Our data showed that there were no significant differences in deep venous thrombosis, pulmonary embolism, myocardial infarction and cerebrovascular accident. These results were consistent with recent studies on the topical application of TXA in hip fractures [21,22,25]. Coagulation function was also evaluated and perioperative PT, INR, APTT and D-dimer were no significant difference between two groups in this study.…”

Section: Discussionsupporting

confidence: 93%

“…These differences could be due to the different internal fixation methods, mode of application and the dosage of TXA. Our results is similar to Drakos et al report [21] and showed a 42.6% reduction in transfusion requirements in the study group. In consideration of administration before wound closure does not reduce intraoperative bleeding, we soaked TXA in the wound for 5 min after greater trochanter exposure and before wound closure.…”

Section: Discussionsupporting

confidence: 93%

“…Only two literatures reported the effects of topical application of TXA in intertrochanteric fracture patients with short cephalomedullary nail, dynamic hip screw and barrel plate, but not PFNA. Drakos et al reported a randomized prospective trial in 200 intertrochanteric fractures treated with a short cephalomedullary nail [21]. The patients received 3 g of TXA in the subfascial plane and around the fracture site before wound closure.…”

Section: Discussionmentioning

confidence: 99%

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Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

Wei

Huang

et al. 2020

Preprint

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Background: The specific method and dose of tranexamic acid (TXA) topically applied in intertrochanteric fracture have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically treated by our protocol in perioperative bleeding management for elderly patients with intertrochanteric fracture treated undergoing proximal femoral nail anti-rotation (PFNA). Methods: A retrospective comparative analysis was performed. Group TXA was comprised of 82 patients with topical use of TXA and group control was comprised of 82 patients without TXA during the procedure of PFNA. Intraoperative, total and hidden blood loss, drainage volume, postoperative blood transfusion volume and complications were compared between the two groups. Results: Intraoperative, total and hidden blood loss, and drainage volume were significantly lower in the TXA group than those in the control group (P=0.012, P<0.01, P<0.01, P=0.014, respectively). The volume and rate of blood transfusion in TXA group were significantly lower than those in the control group (P<0.01). There were no significant differences in complications between two groups (P>0.05). Conclusion: Topical application of TXA offers an effective and safe option in reducing perioperative blood loss and transfusion for elderly patients with intertrochanteric fractures undergoing PFNA.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

Wei

Huang

et al. 2020

Preprint

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“…We used a low dose and systemic administration, as reported by Wingerter et al [ 33 ]. In contrast, Drakos et al [ 23 ] administered 3 g of TXA around the fracture site at the end of the surgical procedure in patients undergoing surgery for intertrochanteric fracture, and Tengberg et al [ 13 ] administered 1 g of TXA as an intravenous bolus prior to surgery followed by a postoperative 24-h infusion of 3 g TXA in 1 L of isotonic saline in patients undergoing surgery for extracapsular hip fracture.…”

Section: Discussionmentioning

confidence: 99%

“…One study showed that TXA decreased external blood loss by 30%, but not hidden blood loss, in total knee replacement [ 19 ]. Other reports in total knee arthroplasty show that TXA significantly reduced hidden blood loss and total blood loss [ 20 – 22 ], but there have been few studies investigating whether TXA can reduce hidden blood loss in surgery for intertrochanteric fractures [ 18 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial

et al. 2017

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BackgroundHidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture.MethodsA total of 77 patients with intertrochanteric fracture were enrolled in this randomized controlled study. Patients received either 200 mL (1 g) of TXA (n = 37) or normal-saline (NS) (n = 40) i.v. before hip surgery using proximal femoral nail anti-rotation (PFNA). Hemoglobin and hematocrit levels were measured preoperatively and postoperatively at day 1 and 3. Visible and hidden blood loss volumes were calculated at postoperative day 3.ResultsOn postoperative day 3, the transfusion rate was significantly lower in the TXA group compared to the NS group, although mean hemoglobin and hematocrit levels were not significantly different between the two groups. However, the estimated hidden blood loss volume (210.09 ± 202.14 mL vs. 359.35 ± 290.12 mL; P < 0.05) and total blood loss volume (279.35 ± 209.11 mL vs. 417.89 ± 289.56 mL; P < 0.05) were significantly less in the TXA group compared to the NS group, respectively.ConclusionTXA significantly reduced postoperative hidden blood loss in patients with intertrochanteric fracture who underwent PFNA.(Registration number: ChiCTR-INR-16008134).

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Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

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Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

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Efficacy of Local Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing Intertrochanteric Fracture Surgery

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 66 publications

References 40 publications

Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

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