Intravenous Tranexamic Acid Decreases Blood Transfusions and Blood Loss for Patients with Surgically Treated Hip Fractures

Abstract

Introduction Tranexamic acid can decrease blood loss related to surgery and trauma. The primary objective of this study is to examine if the use of a single dose of peri-operative TXA significantly decreases the rate of allogenic blood transfusions in the setting of operative care of hip fractures. Secondary objectives included examining if total blood loss was decreased by TXA in operative hip fractures as well as examining the safety of TXA by measuring the rates venous thromboembolism (VTE). Methods Retrospective chart review of 505 patients who were operatively treated for hip fractures at a single facility was performed. In a non-randomized fashion, 307 patients received TXA and 198 patients did not. Patients received 1 gram of TXA prior to incision. Blood transfusion was the primary end point. Blood loss was calculated using the hemoglobin balance method. Chart was reviewed for VTE events during hospitalization. Results 505 patients were analyzed. The use of single perioperative dose of TXA in the surgical management of hip fracture resulted in absolute risk reduction of transfusion of 7.7% and relative risk reduction of transfusion by 29%. This was statistically significant with P =.04. Patients who received TXA on average lost 235 ml less blood compared to those who did not receive TXA ( P <.0001). No increase in VTE events were found in either group during hospitalization. Conclusion This study supports the use of TXA is decrease blood loss and transfusion rates in patients with hip fractures. TXA can be used routinely to decrease complications in this usually fragile population.

Does tranexamic acid reliably reduce blood loss in proximal femur fracture surgery?

“…Whilst Zufferey recorded an increase of vascular events, mainly asymptomatic deep vein thromboses, Tengberg stated a higher 90 days mortality rate (27.2 vs 10%) [20,21]. Further studies also underline our findings of both reduced blood loss and decreased transfusion rates and have postulated that tranexamic acid should be a standard protocol for proximal femoral fractures [18,19,30]. Our findings support that subtrochanteric fractures lead to the highest total blood loss and can also benefit from the use of tranexamic acid, as also proven by Lei and Tengberg [21,31].…”

“…Patients with hip fractures are particularly vulnerable and at risk for deep vein thrombosis so special consideration should be given to these possible complications that might restrict the use of tranexamic acid. Recent studies have been investigating the use in mono-trauma patients concentrating on femoral neck fractures [18][19][20][21].…”

Does Tranexamic acid Reduce Blood Loss and Transfusion Rate in Undernourished Patients with Hip Fracture?

“…TXA has been widely used to reduce bleeding and postoperative transfusion in geriatric hip fracture owing to its effectiveness and safety as a potent anti brinolytic [14][15]. On the other hand, geriatric nutritional problems including undernutrition, sarcopenia, and frailty have signi cant impacts on disability, occurrence of complications, and mortality after hip fractures [9].…”