The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis

Abstract

Aim: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion. Methods: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements. Results: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed. Conclusion: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event. Level of Evidence: Level III-retrospective comparative study.

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

“…The same results were found in other studies. 60,61 For example, Atalay et al 60 cancer lesions of the proximal femur. Other studies investigated different modalities of TXA use.…”

“…The same results were found in other studies. 60 , 61 For example, Atalay et al 60 demonstrated that preoperative TXA (15 mg/kg as a bolus) significantly reduced postoperative bleeding amount and transfusion needs in wide-margin tumor resection and prosthesis surgery for cancer lesions of the proximal femur. Other studies investigated different modalities of TXA use.…”

“… TXA N/E PLACEBO N/E TXA 981 ± 290 mL PLACEBO 1542 ± 746 mL TXA 8 (23.5%) PLACEBO 25 (44.6%) TXA 1 (2.9%) PLACEBO 2 (3.6%) S for 24h blood loss and blood transfusion NS for VTE Varady NH (2021) 59 United States Hip/knee arthroplasty 282 1 g intravenous TXA preoperatively and 1 g intrevenous TXA during wound closure. TXA N/E PLACEBO N/E TXA N/E PLACEBO N/E TXA N/E PLACEBO N/E TXA 3 (4.1%) PLACEBO 20 (9.6%) NS for VTE Atalay İB (2020) 60 Turkey Tumor resection and reconstruction 46 Preoperative bolus 15 mg/kg TXA. TXA 1026.7± 727.9 PLACEBO 1290.3± 490.1 TXA 433.3± 327.1 PLACEBO 517.7± 201.1 TXA 7 (46.7%) PLACEBO 29 (93.5%) TXA 0 PLACEBO 0 S for 24h blood loss and blood transfusion NS for perioperative blood loss Abbreviations : TXA, tranexamic acid; NS, not significant; S, significant; DVT, deep venous thrombosis; VTE, venous thromboembolism.…”

Intravenous tranexamic acid reduces complications following surgical treatment of pathologic fractures of the lower extremity

“…For example, in a study of 90 patients undergoing endoprosthetic reconstruction for pathologic fractures secondary to primary sarcoma and metastatic bone disease, Hasse et al identified decreased odds of blood transfusion among individuals who received TXA (TXA[+]: 21% lower frequency of transfusions, p = 0.04) compared to those who did not. Similarly, outcomes following TXA administration in a 46‐patient series by Atalay et al studying patients with proximal femoral tumor resection for femoral bone malignancies demonstrated a decreased risk of transfusion (rate of transfusion: TXA[+] 46% vs. TXA[−] 93.5%, p = 0.001) 13,14 . Alternatively, Owen et al found no significant difference in their study looking at transfusion rates in 66 individuals following bipolar hemiarthroplasty for impending or completed pathologic fracture of the femoral neck (TXA[+]: 36.4% vs. TXA[−]: 36.4%, p = 1.000) 15 .…”

“…[10][11][12] Currently, the literature regarding TXA utilization for neoplastic diseases of the lower extremity is limited to three studies. [13][14][15] As such, orthopedic oncologic surgeons may be hesitant to administer IV TXA before surgery for neoplastic pathologic fractures of the lower extremity due to the concern that the antifibrinolytic properties of TXA inhibiting clot dissolution may exacerbate the risk of VTE in these hypercoagulable individuals. 13,14,16,17 Thus far, this has yet to be proven.…”