Tranexamic acid administration to older patients undergoing primary total hip arthroplasty conserves hemoglobin and reduces blood loss

Abstract

Tranexamic acid administration to older patients undergoing primary total hip arthroplasty conserves hemoglobin and reduces blood loss Background: Tranexamic acid effects in older people are difficult to predict. This study investigated the following research questions: 1) Is tranexamic acid effective in older patients undergoing primary total hip arthroplasty (THA)? and 2) Is there a difference in the effect of tranexamic acid between younger and older patients? Methods: This was a 2-phase retrospective matched-pair study of patients who underwent THA in 2007-2013. All procedures were performed by surgeons with at least 10 years' experience as senior consultant. In the first phase, 58 patients aged 65 years or more who received tranexamic acid were matched 1:1 with patients who did not receive tranexamic acid for age, sex, American Society of Anesthesiologists (ASA) classification and body mass index. In the second phase, 58 patients aged 65 years or more who received tranexamic acid were matched 1:1 with patients less than 65 years of age who received tranexamic acid for sex, ASA classification and body mass index. The primary outcome measures were percent maximum decrease in hemoglobin level and estimated blood loss after surgery. Results: In the first phase, patients who received tranexamic acid conserved postoperative hemoglobin by a mean of 10.26 g/L (standard deviation [SD] 9.89 g/L) compared to the control group (p < 0.001). The mean difference in the estimated perioperative blood loss between the 2 groups was 410 mL (SD 376 mL) (p < 0.001), which indicated less bleeding in the treatment group. In the second phase, there was no difference between the younger (mean age 55.1 [SD 7.28] yr) and older (mean age 75.6 [SD 6.35] yr) groups in mean lowest postoperative hemoglobin level or percent decrease in hemoglobin level. Conclusion: Tranexamic acid reduced the postoperative decrease in hemoglobin level and blood loss in older patients. Moreover, the significant hemoglobin-sparing effect of tranexamic acid in older patients was similar to that observed in younger patients. Contexte : Les effets de l'acide tranexamique sont difficiles à prévoir chez les personnes âgées. Avec cette étude, nous avons voulu répondre aux 2 questions suivantes : 1) L'acide tranexamique est-il efficace chez les patients âgés soumis à une intervention chirurgicale primaire pour prothèse totale de la hanche (PTH)?, et 2) L'acide tranexamique produit-il un effet différent selon que les patients sont jeunes ou âgés? Méthodes : Cette étude rétrospective en 2 phases sur des paires appariées a regroupé des patients soumis à une intervention pour PTH entre 2007 et 2013. Toutes les interventions ont été effectuées par des chirurgiens détenant au moins 10 ans d'expérience à titre de consultants principaux. Au cours de la première phase, 58 patients de 65 ans ou plus ayant reçu de l'acide tranexamique ont été assortis (rapport 1:1), selon l'âge, le sexe, la classification ASA (American Society of Anesthesiologists) et l'indice de masse corporel...

Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

“…Concerning age, El Beheiry et al concluded that TXA had a similar hemoglobin-sparing effect in patients over 65 years old undergoing primary total hip arthroplasty compared with younger patients. 21 We also reported that age didn't influence perioperative bleeding because no correlation was found between blood loss and age in both control and TXA Groups.…”

Less Blood Loss With Tranexamic Acid in Primary Total Hip Arthroplasty Using the Direct Anterior Approach: a One-center Retrospective Observational Study

“…Many literatures [11,24,25] have reported that the use of TXA did not increase the incidence of DVT in patients undergoing THA. However, Nishihara et al [26] conducted a study to observe whether TXA increased the risk of DVT in lower limbs without routine chemical thromboprophylaxis, and nally found that the use of TXA would increase in the incidence of distal DVTs in the muscular veins.…”

Tranexamic Acid Combined with Compression Bandage Following Total Knee Arthroplasty Promotes Blood Coagulation: A Retrospective Analysis

“…During the TKA operation, 800-1800 mL of perioperative blood loss may occur during the period despite the use of tourniquets and gel ice [ 13 ]. In recent studies, many evidences have shown the beneficial effects of TXA in lowering blood loss in orthopedic surgeries, which plays a big role in inflammatory response [ 5 , 6 , 9 ]. Karaduman et al evaluated the hematological parameters with TKA between the conventional method such as ice packs and cryotherapy, and they found that postoperative cryotherapy might be a potential, simple, and noninvasive option for TKA patients [ 13 ].…”

“…Tranexamic acid (TXA) is a lysine derivative, which is structurally similar to lysine. It can be associated with lysine targets on the plasminogen to help cut the interaction between fibrin and heavy chain of plasmin, thus directly lead to the promotion of coagulation process and the control of postoperative blood loss [ 4 , 5 ].Furthermore, TXA is often injected intravenously or intra-articularly so as to weaken the perioperative blood loss of TKA [ 6 – 9 ] in many clinical practices. And then, there are also a number of studies that have found that TXA maybe play an important effect on inflammatory response other than reduce blood loss [ 5 , 10 , 11 ].…”