Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Abstract

Purpose Tranexamic acid (TXA) reduces need for transfusion in total joint arthroplasty, though findings in acetabular surgery are conflicting. We compared outcomes after acetabular fracture surgery with or without perioperative intravenous (IV) TXA administration. Methods We performed a retrospective review of 305 patients with acetabular fractures that underwent open reduction and internal fixation (ORIF). Eighty-nine patients received TXA, and 216 did not. The primary outcome was rates of intraoperative and postoperative allogeneic blood transfusion. Results Baseline demographics and characteristics were similar. Time from injury to surgery and estimated blood loss were comparable. Operative time (p < 0.01) and intraoperative IV fluids (p < 0.01) were greater in the non-TXA group. The proportion of patients who received blood transfusion and mean units transfused intraoperatively and postoperatively did not differ. Mean differences in preoperative and postoperative hemoglobin and hematocrit, hospital length of stay, and perioperative complications also did not differ. In a multivariable regression model, age 60-70 years, Charlson Comorbidity Index, Injury Severity Score, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approaches and intraoperative transfusion requirement were independently associated with postoperative transfusion. Conclusion In this study, perioperative IV TXA did not decrease blood loss, need for transfusion, or improve in-hospital outcomes of acetabular fracture surgery. Age 60-70, CCI, ISS, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approach and need for intraoperative transfusion were independently associated with postoperative transfusion. Further prospective trials are warranted to confirm these findings

Early Treatment of Acetabular Fractures via an Anterior Approach Increases Blood Loss but not Packed Red Blood Cell Transfusion

“…This is consistent with a recent study that showed there was no benefit regarding transfusion rate when using TXA for acetabular fracture ORIF; however, in that study, there was an increased operating room (OR) time and increased IV fluids given in those who did not receive TXA. 24 Another prospective randomized study showed no effect when TXA was given with acetabulum fracture ORIF. 25 Notably, administering prophylactic anticoagulation for venous thromboembolism on the morning of surgery also did not affect blood loss.…”

Update on Applications and Limitations of Perioperative Tranexamic Acid

“…13 TXA use for elective long bone procedures and repair of bone fractures has undergone several investigations. 99,103,104 Patients with acute fractures differ from elective patients in that they usually face urgent/emergent surgery and may have increased risks associated with thrombosis. An analysis of the use of TXA for surgical repair of hip fractures demonstrated efficacy in terms www.anesthesia-analgesia.org…”

“…TXA use for elective long bone procedures and repair of bone fractures has undergone several investigations. 99,103,104 Patients with acute fractures differ from elective patients in that they usually face urgent/emergent surgery and may have increased risks associated with thrombosis. An analysis of the use of TXA for surgical repair of hip fractures demonstrated efficacy in terms of reduced total blood loss (mean difference, –273 mL; 95% CI, –353 to –193 mL; P <.0001) and blood transfusion rates (risk ratio, 0.66; 95% CI, 0.56–0.78; P < .003) without evidence of thromboembolic events (risk ratio, 1.38; 95% CI, 0.74–2.55; P = .31).…”

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…One RCT has demonstrated no effect of TXA in acetabular fracture surgery in terms of transfusions (50 % vs. 32 %) or blood loss, but with only 88 patients included, this could be a power issue [32]. Even though there are two retrospective studies [33,34], with a total of 220 patients demonstrating lower transfusion rate and blood loss, it contrasts with a larger retrospective study [35] including 305 patients that did not demonstrate a statistically significant difference in transfusions or blood loss. Patients with acetabular fractures are often multi-trauma patients, and a single dose of TXA perioperatively may not have a sufficient effect if the patient has been bleeding from other sites.…”