Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Hip Fracture Undergoing Arthroplasty

Abstract

Background:Tranexamic acid (TXA) is considered safe and efficacious for elective total joint arthroplasty. However, evidence of TXA’s safety in high-risk patients with hip fracture requiring nonelective arthroplasty has been lacking. This study aimed to assess whether TXA administration to high-risk patients with a hip fracture requiring arthroplasty increased the risk of thrombotic complications or mortality.Methods:All patients who underwent hip hemiarthroplasty (HHA) or total hip arthroplasty (THA) for displaced femoral neck fractures between 2011 and 2019 at 4 sites within 1 hospital system were retrospectively identified. Patients were grouped by risk (high-risk or low-risk) and TXA treatment (with or without TXA). Propensity scores were used for risk adjustment in comparisons between surgery with and without TXA for only the high-risk group (n = 1,066) and the entire population (n = 2,166). Differences in the occurrence of postoperative mortality, deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke within 90 days of hip arthroplasty were evaluated.Results:TXA administration was not associated with an increased risk of thrombotic complications or mortality within 90 days in either high-risk or all-patient groups. Specifically, among 1,066 matched high-risk patients who did not or did receive TXA, there were no significant differences in mortality (14.82% and 10.00%; p = 0.295), deep venous thrombosis (3.56% and 3.04%; p = 0.440), pulmonary embolism (2.44% and 1.96%; p = 0.374), myocardial infarction (3.38% and 2.14%; p = 0.704), or stroke (4.32% and 5.71%; p = 0.225).Conclusions:In our review of 1,066 propensity-matched high-risk patients undergoing hip arthroplasty for displaced femoral neck fractures, we found that TXA administration (compared with no TXA administration) was not associated with an increased risk of mortality, deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Field tourniquets in an austere military environment: A prospective case series

“…Schiavone et al [34] found that tranexamic acid given at the time of surgical incision significantly reduced blood loss in nailing of pertrochanteric femur fractures. Similarly, Porter at al [35] found that use of tranexamic acid in high-risk patients undergoing arthroplasty for hip fractures was not associated with an increased There are several limitations of our study. First, although our study was adequately powered for the parameters of systolic and diastolic blood pressure, but it did not have the large patient numbers required to further refine statistical analysis.…”

A nationwide study of blood transfusion in hip fracture patients

“…25 further information regarding different timing and dosing regimens, national standardization, and potential use in high-risk patient groups may help to further expand its role. [26][27][28] previous evidence has demonstrated lower use of tXa in those undergoing hip fracture fixation compared to arthroplasty operations, 27 even though our findings suggest potential for far greater benefit in the former population. use of intraoperative cell-salvage for hip fracture patients has also been touted as another possibility for reducing intraoperative blood loss, 29 and a rct exploring the potential benefits of this approach is underway, although currently suspended.…”

Is there a difference between tranexamic acid application routes in hip hemiarthroplasty?

“…In recent years, there have been publications on the use of TA during the surgical treatment of hip fractures. However, these are studies with different treatment methods or in which only TA is applied in one way [10][11][12][13][14][15]. A study comparing hemiarthroplasty with local and systemic applications with the diagnosis of femoral neck fracture could not be seen in the literature.…”