Matched cohort study of topical tranexamic acid in cementless primary total hip replacement

Evaluation of Efficacy of Tranexamic Acid on Blood Loss in Surgically Managed Intertrochanteric Fractures

Introduction

Intertrochanteric (IT) fracture surgeries make up a significant portion of trauma operations worldwide. The routine use of tranexamic acid (TXA) for these surgeries is not common in current practice at most places. This prospective study evaluated its efficacy in reducing perioperative blood loss and accentuating its potential for a better outcome.

Materials and Methods

A total of 100 patients were divided equally into two groups, A and B. Group A was given preoperative intravenous (IV) TXA and intraoperative topical TXA through the drain, while Group B was given preoperative and intraoperative normal saline. Both groups were comparable in age, body mass index, preoperative hemoglobin (Hb), surgery performed, and duration of surgery.

Results

The mean drain volume, postoperative Hb, fall of Hb, and total blood loss were all significantly less in Group A as compared to Group B (P < 0.01). None of the patients in either group received more than one unit of blood transfusion. No complications were seen in any of the patients till the final follow-up.

Conclusion

In comparison to other studies, our study is in agreement that TXA overall helps in blood conservation; however, our study is unique in the way that the combination of preoperative IV and intraoperative topical TXA has resulted in the best possible results.

Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the 2 groups.The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P = .012, P < .01, P < .01, P = .014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P < .01). There were no significant differences in complications between the 2 groups (P > .05).Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

Topical tranexamic acid in elderly patients with femoral neck fractures treated with hemiarthroplasty: efficacy and safety? - a case-control study

Background

Perioperative blood management is an important issue in the treatment of elderly patients at an increased risk of postoperative complications. Accordingly, tranexamic acid (TXA) is widely administered to reduce blood loss and transfusion requirements. In this case-control study, the effect of topical TXA on the outcomes of elderly patients with femoral neck fractures after hemiarthroplasty was evaluated.

Methods

This study enrolled elderly patients (age ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between January 2015 and January 2017. The study group comprised 72 patients who received TXA via topical administration during surgery. After propensity matching, the control group comprised 72 patients who did not receive topical TXA. The perioperative and postoperative parameters of the two groups were compared.

Results

The estimated blood loss, vacuum tube drainage, and total transfusion volume were significantly lower in the study group than the control (p = 0.024, 0.003, and 0.019, respectively). Despite a lack of significant intergroup differences in the lengths of ICU and hospital stays; rates of ICU admission, venous thromboembolism, delirium, and readmission; and rates of in-hospital and 1-year mortality, the incidence of postoperative medical complications was significantly lower in the study group (p = 0.003).

Conclusion

Topical TXA administration appears to be a simple and effective option for reducing blood loss, transfusion requirements, and medical complications after hemiarthroplasty in elderly patients with femoral neck fractures.