Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial

Abstract

Purpose Elderly patients with intertrochanteric fractures exhibit post-traumatic hidden blood loss (HBL). This study aimed to evaluate the efficacy and safety of reducing post-traumatic HBL via early intravenous (IV) tranexamic acid (TXA) intervention in elderly patients with intertrochanteric fracture. Methods A prospective randomized controlled study was conducted with 125 patients (age ≥ 65 years, injury time ≤ 6 h) who presented with intertrochanteric fracture from September 2018 and September 2019. Patients in the TXA group (n = 63) received 1 g of IV TXA at admission, whereas those in the normal saline (NS) group (n = 62) received an equal volume of saline. Hemoglobin (Hgb) and hematocrit (Hct) were recorded at post-traumatic admission (PTA) and on post-traumatic days (PTDs) 1–3. HBL was calculated using the Gross formula. Lower extremity venous ultrasound was performed to detect venous thrombosis. Results Hgb on PTDs 2 and 3 was statistically higher in the TXA group than in the NS group. Hct and HBL on PTDs 1–3 were significantly less in the TXA group compared to the NS group. Preoperative transfusion rate was significantly lower in the TXA group compared with the NS group. There was no difference between the two groups with regard to the rates of complications. Conclusion Early IV TXA intervention could reduce post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis.

Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

“…Yang et al [ 22 ] confirmed that after the application of TXA, the blood transfusion rate of hip replacement decreased from 22.4 to 5.7%. Research has shown that patients who receive TXA have significantly less total blood loss than patients who do not [ 23 ].…”

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…Another meta-analysis only included intertrochanteric fractures treated with intramedullary nail (n = 539) and generated similar findings [22]. Three relevant RCTs have since been published [23,24,25]. Ma et al [23] administered TXA early in the emergency ward to patients with intertrochanteric fractures, which led to fewer transfusions pre-operatively (23 % vs. 11 %), including less hemoglobin change postoperatively.…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“…The significant reduction in hidden blood loss, as determined by hemoglobin levels, as well as the reduction in preoperative transfusions in the TXA group highlights the potential of the drug in improving patient stability and reducing the likelihood of complications associated with acute trauma. 41 Two more meta-analyses reported on patients receiving TXA while undergoing surgical fixation for unspecified hip fractures, and both noted a significant decrease in transfusion rates in the TXA group without a concurrent increase in the incidence of thromboembolic events. 43 , 44 A meta-analysis by Gausden et al included studies with a variety of orthopedic trauma pathologies including femoral neck, hip, intertrochanteric, calcaneal, acetabular, and femoral shaft fractures.…”

“… Abildgaard et al, 2016 36 SA Retrospective comparison 77 TSAs and 94 RTSAs performed in 168 patients. Use of TXA perioperatively in patients undergoing primary shoulder arthroplasty can decrease perioperative blood loss, change in Hgb and Hct, and postoperative drain output Trauma Zhu et al, 2018 40 ITF Meta analysis 7 RCTs 746 patients - Administration of TXA in Intertrochanteric Fracture Surgery significantly reduced surgical blood loss and total blood loss - It had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events Ma et al, 2021 41 ITF RCT 125 patients Early IV TXA intervention was shown to reduce post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis. Zhang et al, 2018 42 FF Meta analysis 12 RCTs, and one was a retrospective cohort study.…”