Tranexamic acid in hip fracture surgery: a randomized controlled trial

Zufferey, P.; Miquet, M.; Quenet, Sara; Martin, P.; Adam, P.; Albaladéjo, Pierre; Mismetti, Patrick; Molliex, Serge

doi:10.1093/bja/aep314

Cited by 190 publications

(184 citation statements)

References 30 publications

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“…Regional anaesthesia and anti-fibrinolytic agents (tranexamic acid) potentially reduce intra-operative bleeding [77,84], but their effect on outcome linked specifically to anaemia and/or transfusion is unknown.…”

Section: Intra-operative Managementmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Intra-operative Managementmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…Antifibrinolytic drugs are widely used to reduce blood loss in a variety of hemorrhagic conditions, including severe trauma (1), cardiac and non-cardiac surgery (2)(3)(4)(5), and maternal hemorrhage (6). Safe and effective pharmacological blood conservation strategies are needed, as the risks and costs associated with allogenic blood transfusions continue to increase (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Glycine receptors are predominantly expressed in the spinal cord and brain stem but are also widely expressed in the prefrontal cortex, the hippocampus, and the amygdala (32). These receptors are pentameric chloride ion channels that are composed of α [1][2][3][4] and β subunits (33). The subunit composition of each receptor determines its pharmacological properties, as well as its expression patterns in the CNS and the subcellular regions of neurons (34).…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid concentrations associated with human seizures inhibit glycine receptors

Lecker¹,

Wang²,

Romaschin³

et al. 2012

J. Clin. Invest.

171

156

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Antifibrinolytic drugs are widely used to reduce blood loss during surgery. One serious adverse effect of these drugs is convulsive seizures; however, the mechanisms underlying such seizures remain poorly understood. The antifibrinolytic drugs tranexamic acid (TXA) and ε-aminocaproic acid (EACA) are structurally similar to the inhibitory neurotransmitter glycine. Since reduced function of glycine receptors causes seizures, we hypothesized that TXA and EACA inhibit the activity of glycine receptors. Here we demonstrate that TXA and EACA are competitive antagonists of glycine receptors in mice. We also showed that the general anesthetic isoflurane, and to a lesser extent propofol, reverses TXA inhibition of glycine receptor-mediated current, suggesting that these drugs could potentially be used to treat TXA-induced seizures. Finally, we measured the concentration of TXA in the cerebrospinal fluid (CSF) of patients undergoing major cardiovascular surgery. Surprisingly, peak TXA concentration in the CSF occurred after termination of drug infusion and in one patient coincided with the onset of seizures. Collectively, these results show that concentrations of TXA equivalent to those measured in the CSF of patients inhibited glycine receptors. Furthermore, isoflurane or propofol may prevent or reverse TXA-induced seizures.

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“…1 Around 50% of patients undergoing hip surgery require at least 1100 ml of blood transfusion. 2 Blood transfusion also has its demerits like it can cause severe immunological reactions and also be a source of various blood-borne infections 3 . Now a days methods used to decrease intraoperative blood loss are permissive hypotension, topical freezing saline, thromboplastic agent and intraoperative administration of anti-fibrinolytic agent like tranexamic acid (TXA).…”

Section: Introductionmentioning

confidence: 99%

A randomized control trial: effect of tranexamic acid on the need of post-operative blood transfusion following total hip replacement surgery

Chaudhary

Khan

2016

Int J Res Med Sci

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Tranexamic acid in hip fracture surgery: a randomized controlled trial

Abstract: In hip fracture surgery, tranexamic acid reduces erythrocyte transfusion but may promote a hypercoagulable state. Thus, further evaluation of safety is required before recommending the off-label use of tranexamic acid.

Cited by 190 publications

References 30 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Tranexamic acid concentrations associated with human seizures inhibit glycine receptors

A randomized control trial: effect of tranexamic acid on the need of post-operative blood transfusion following total hip replacement surgery

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