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

Xu, Hui; Wang, Hairuo; Long, Xiaotao; Xu, Zexiang; Chen, Xiaohua; Li, Mingjin; He, Tong‐Chuan; Wang, Wei; Liu, Lei; Liu, Xi

doi:10.21203/rs.3.rs-28525/v1

Cited by 1 publication

(8 citation statements)

References 13 publications

(14 reference statements)

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“…13,16,17 The findings in the current study are in agreement with those reported by Baskaran and Ma. 13,18 However, it is important to note that our cohort of patients were not confined to only intertrochanteric fractures, and included all types of hip fractures which may increase the generalizability of our reported findings to better define TXA guidelines.…”

Section: Discussionsupporting

confidence: 93%

“…The safety profile of TXA administration (compared to no TXA treatment) in fragility hip fracture patients is well reported and has not been associated with an increased risk of mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, or stroke. 1,7,10,11,13,19 Additionally, the 4-dose TXA model used at our institution has been shown to have no increase in vascular thrombotic events in hip fracture patients compared to those who received no TXA treatment. Although the number of patients in the current study receiving only the admission dose of TXA was small (n = 32), there was no significant difference in adverse events between patients who received TXA doses only at hospital admission compared to those who received the 4-dose TXA protocol (n = 183).…”

Section: Discussionmentioning

confidence: 84%

“…While previous studies have reported significant decreases in post-operative transfusions with the use of a singular TXA admission dose in hip fractures, the comparison groups in these studies received no TXA treatment. 1,13 Therefore, it is unclear how the admission dosing of TXA compares to other regimens of TXA dosing in patients with fragility hip fractures While the clinical practice guidelines noted by the American Association of Hip and Knee Surgery report that there are no differences in single vs multiple doses of TXA in arthroplasty patients, such recommendations are unavailable for patients with hip fractures undergoing surgery. 1,15 In the current study, patients who received isolated TXA admission doses had significantly lower rates of transfusion rates compared to those patients who received the two-dose based arthroplasty TXA protocol (at the time of operative incision and in the PACU).…”

Section: Discussionmentioning

confidence: 99%

“…10,12 However, unlike arthroplasty patients whose bleeding starts at the time of surgical incision, hip fractures patients likely have differences in bleeding at the time of the injury. 13 As such, more clinical data is needed to examine early TXA administration and its effect on transfusion rates in patients with fragility hip fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, few studies have investigated TXA administration upon hospital admission for fragility hip fractures. 1,13 Drawing from both the arthroplasty and trauma literature, a recent study conducted at our institution showed that a novel standardized hybrid TXA protocol of 4 doses, starting at the time of admission and continuing through the post-operative time period, significantly decreased transfusion rates in patients undergoing surgery for hip fragility fractures without an increase in the rate of adverse events. 1 However, the independent timing of these doses within the established hybrid model and its effect on decreasing transfusion rates has not been established.…”

Section: Introductionmentioning

confidence: 99%

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Tranexamic Acid Administration at Hospital Admission Decreases Transfusion Rates in Geriatric Hip Fracture Patients Undergoing Surgery

Moran

Kahan

Morris

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction The timing of tranexamic acid (TXA) administration in fragility hip fracture patients is controversial. Prior studies have demonstrated reduction in transfusion requirements using the two-dose arthroplasty model. However, unlike arthroplasty patients whose bleeding starts at the time of surgical incision, hip fractures have an onset of bleeding at the time of the injury. The primary goal of this study was to evaluate the optimal timing of TXA administration and to determine its effect on red blood cell transfusions in fragility hip fracture patients. Methods All patients admitted to the fragility hip fracture service from April 1, 2019 to September 30, 2019 were prospectively screened for inclusion in the study. Eligible patients received 4 intravenous doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture >48 hours prior to presentation. A subset of patients received only admission TXA dosing and a separate subset of patients received only incision and post op TXA dosing. Red blood cell transfusions, major adverse vascular events, and minor drug and infusion-related adverse events were recorded for all subgroups of patients. Results A total of 508 patients were eligible for analysis. In total, 180 patients received no TXA, 32 patients only received the admission doses of TXA, 112 patients received only the arthroplasty based (incision and post op) doses of TXA, and 183 patients received all 4 doses of TXA. The transfusion rate was significantly lower in patients who received all 4 doses of TXA (8.7%) and in those who only received one dose of TXA at admission (9.4%) compared to patients who received TXA at incision and recovery room (25.7%) or those patients who did not receive TXA prophylaxis (29.4%) (P = 0.001). Additionally, the transfusion rate for intramedullary nailing was higher compared to patients undergoing any other procedure (27% vs 13.8%, P < 0.001). Conclusions Patients with fragility hip fractures who received IV TXA at hospital admission have significantly lower transfusion rates compared to those who received no tranexamic acid or those who received two dose-TXA (at the operative incision and in the post-operative recovery room). These findings suggest that isolated dosing of TXA at hospital admission may be more effective at reducing post-operative bleeding than the traditional arthroplasty dosing (incision and post-op doses) and is equally as effective as the 4-dose TXA protocol in hip fracture patients undergoing surgery.

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