Is intravenous tranexamic acid effective and safe during hip fracture surgery? An updated meta-analysis of randomized controlled trials

Xiao, Cong; Zhang, Shaoyun; Long, Nengji; Yu, Wei; Jiang, Yishan

doi:10.1007/s00402-019-03118-6

Cited by 41 publications

(39 citation statements)

References 30 publications

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“…There was a good correlation between TXA plasma concentration and LT TPA-test (r = 0.55; p < 0.0001). Effective lysis inhibition ex vivo could be seen in all samples 30 Fig. 1C).…”

Section: In Vivo Studymentioning

confidence: 79%

Functional Testing for Tranexamic Acid Duration of Action Using Modified Viscoelastometry

Kämmerer

Groene

Sappel

et al. 2020

Transfus Med Hemother

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Introduction: Tranexamic acid (TXA) is the standard medication to prevent or treat hyperfibrinolysis. However, prolonged inhibition of lysis (so-called “fibrinolytic shutdown”) correlates with increased mortality. A new viscoelastometric test enables bedside quantification of the antifibrinolytic activity of TXA using tissue plasminogen activator (TPA). Materials and Methods: Twenty-five cardiac surgery patients were included in this prospective observational study. In vivo, the viscoelastometric TPA test was used to determine lysis time (LT) and maximum lysis (ML) over 96 h after TXA bolus. Additionally, plasma concentrations of TXA and plasminogen activator inhibitor 1 (PAI-1) were measured. Moreover, dose effect curves from the blood of healthy volunteers were performed in vitro. Data are presented as median (25–75th percentile). Results: In vivo TXA plasma concentration correlated with LT (r = 0.55; p < 0.0001) and ML (r = 0.62; p < 0.0001) at all time points. Lysis was inhibited up to 96 h (LTTPA-test: baseline: 398 s [229–421 s] vs. at 96 h: 886 s [626–2,175 s]; p = 0.0013). After 24 h, some patients (n = 8) had normalized lysis, but others (n = 17) had strong lysis inhibition (ML <30%; p < 0.001). The high- and low-lysis groups differed regarding kidney function (cystatin C: 1.64 [1.42–2.02] vs. 1.28 [1.01–1.52] mg/L; p = 0.002) in a post hoc analysis. Of note, TXA plasma concentration after 24 h was significantly higher in patients with impaired renal function (9.70 [2.89–13.45] vs.1.41 [1.30–2.34] µg/mL; p < 0.0001). In vitro, TXA concentrations of 10 µg/mL effectively inhibited fibrinolysis in all blood samples. Conclusions: Determination of antifibrinolytic activity using the TPA test is feasible, and individual fibrinolytic capacity, e.g., in critically ill patients, can potentially be measured. This is of interest since TXA-induced lysis inhibition varies depending on kidney function.

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“…There was a good correlation between TXA plasma concentration and LT TPA-test (r = 0.55; p < 0.0001). Effective lysis inhibition ex vivo could be seen in all samples 30 Fig. 1C).…”

Section: In Vivo Studymentioning

confidence: 79%

Functional Testing for Tranexamic Acid Duration of Action Using Modified Viscoelastometry

Kämmerer

Groene

Sappel

et al. 2020

Transfus Med Hemother

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“…Hemoglobin levels and transfusions were also closely related to the risk of the composite outcome. This result could support the use of medications or devices to minimize blood loss in the operating room, such as tranexamic acid, which decreases blood loss in patients with hip fracture [19].…”

Section: Discussionmentioning

confidence: 79%

Outcomes Evaluation after Application of Multidisciplinary Protocol of Shared Hospital Care in Patients Aged 65 Years and Older and Operated for Hip Fracture

Marín¹,

Martínez²,

Ripoll³

et al. 2020

Preprint

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Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.

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“…It possesses great potential in reducing blood loss and allogeneic blood transfusion safely in patients with hip fractures undergoing surgery. Five meta-analyses [116][117][118][119][120] of RCTs comparing intraoperative administration of TXA with placebo in patients undergoing hip fracture surgery showed significant differences between groups regarding transfusion rates of allogeneic blood, total blood loss, intraoperative blood loss, postoperative blood loss and postoperative haemoglobin, without affecting the rates of thromboembolic events, deep venous thrombosis, acute coronary syndrome, cerebrovascular events, wound complications or mortality.…”

Section: Anemia and Patients Blood Managementmentioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Is intravenous tranexamic acid effective and safe during hip fracture surgery? An updated meta-analysis of randomized controlled trials

Cited by 41 publications

References 30 publications

Functional Testing for Tranexamic Acid Duration of Action Using Modified Viscoelastometry

Functional Testing for Tranexamic Acid Duration of Action Using Modified Viscoelastometry

Outcomes Evaluation after Application of Multidisciplinary Protocol of Shared Hospital Care in Patients Aged 65 Years and Older and Operated for Hip Fracture

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

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