Single dose of tranexamic acid effectively reduces blood loss and transfusion rates in elderly patients undergoing surgery for hip fracture: a randomized controlled trial

Abstract

Aims The aim of this study was to investigate the hypothesis that a single dose of tranexamic acid (TXA) would reduce blood loss and transfusion rates in elderly patients undergoing surgery for a subcapital or intertrochanteric (IT) fracture of the hip. Methods In this single-centre, randomized controlled trial, elderly patients undergoing surgery for a hip fracture, either hemiarthroplasty for a subcapital fracture or intramedullary nailing for an IT fracture, were screened for inclusion. Patients were randomly allocated to a study group using a sealed envelope. The TXA group consisted of 77 patients, (35 with a subcapital fracture and 42 with an IT fracture), and the control group consisted of 88 patients (29 with a subcapital fracture and 59 with an IT fracture). One dose of 15 mg/kg of intravenous (IV) TXA diluted in 100 ml normal saline (NS,) or one dose of IV placebo 100 ml NS were administered before the incision was made. The haemoglobin (Hb) concentration was measured before surgery and daily until the fourth postoperative day. The primary outcomes were the total blood loss and the rate of transfusion from the time of surgery to the fourth postoperative day. Results Homogeneity with respect to baseline characteristics was ensured between groups. The mean total blood loss was significantly lower in patients who received TXA (902.4 ml (-279.9 to 2,156.9) vs 1,226.3 ml (-269.7 to 3,429.7); p = 0.003), while the likelihood of requiring a transfusion of at least one unit of red blood cells was reduced by 22%. Subgroup analysis showed that these differences were larger in patients who had an IT fracture compared with those who had a subcapital fracture. Conclusion Elderly patients who undergo intramedullary nailing for an IT fracture can benefit from a single dose of 15 mg/kg TXA before the onset of surgery. A similar tendency was identified in patients undergoing hemiarthroplasty for a subcapital fracture but not to a statistically significant level. Cite this article: Bone Joint J 2021;103-B(3):442–448.

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

“…In this study, the rate of blood transfusion was 10.46% (95% CI : 8.23–13.21), which was lower than report of Nikolaou et al (63.47%) [ 6 ], Ohmori et al (32.67%) [ 33 ], and Guo et al (29.7%) [ 5 ] in hip fracture patients. The reason might be that the blood loss continue until several days after surgery [ 9 ], but this study only analyzed the blood transfusions from admission to the time of blood routine test.…”

“…Even more, it is estimated that there will be 4.5 million hip fractures worldwide by the year 2050, and 1.3 million cases will be in China [ 3 , 4 ]. After the initial injury, hip fracture patients may suffer from a large amount of total blood loss, which vary from 859 ml to 1208 ml in patients with femur neck fracture [ 5 – 7 ], and 406 ml to 1269 ml in patients with intertrochanteric fracture [ 6 , 8 – 11 ]. Similarly, a prospective study found that the blood loss can reach up to 1013 ml even prior to the surgery [ 12 ].…”

“…Blood loss in elderly patients makes them prone to perioperative anemia due to the presence of comorbidities and limited physiological reserve [ 6 ]. Recently, an increasing number of studies have confirmed that low hemoglobin or anemia on admission was significantly associated with increased mortality, postoperative complications, and poorer physical function [ 13 – 15 ].…”

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

“…Patients in the training set were used to develop the nomogram model, whereas patients in the testing set were used to validate the resulting nomogram. The use of TXA involved a single dose of intravenous TXA (15 mg/kg) 30 min prior to surgery in the study [ 10 ]. According to the World Health Organization criteria, the degree of anemia was classified as mild (male, 11-12.9 g/dl; female, 11-11.9 g/dl), moderate (8-10.9 g/dl), or severe (< 8 g/dl) [ 11 ].…”

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

“…A similar tendency was identified in patients undergoing hemiarthroplasty for a subcapital fracture but not to a statistically significant level. [ 21 ] We first reported the effects of topical application of TXA in intertrochanteric fracture patients with PFNA. Our data showed that the TBL was reduced by 30% (from 813–566 mL) and the HBL was reduced by 31% (from 652–447 mL) after topical treatment with TXA during surgery.…”