Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures

Abstract

Objectives: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients. Design: Retrospective cohort study. Setting: Academic Tertiary Care Center. Patients/Participants: Series of 209 patients with fragility hip fractures treated operatively from April 1, 2019 to September 30, 2019. Intervention: Eligible patients received 4 intravenous doses of TXA. Some patients missed doses and only received between 1 and 3 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. Main Outcome Measures: Red blood cell transfusion; major adverse vascular events; minor drug related adverse events. Results: Patients who received all 4 doses of TXA (n = 70) had a significantly lower transfusion rate compared to those who did not receive any TXA (7.1% vs 28.1%, P = .003). There were no significant differences in the number of major or minor adverse events between the 2 groups. Conclusions: The use of a standardized TXA protocol of 4 doses significantly decreases transfusion rates in eligible patients undergoing operative intervention for fragility hip fracture without an increase in major or minor adverse events. These findings are even more pronounced in patients with decreased preoperative hemoglobin. Level of Evidence: Prognostic Level III

Application of Different Doses of Tranexamic Acid Plus Traditional Chinese Medicine in Hip Arthroplasty in Patients with Diabetes and Its Influence on Intraoperative Blood Loss and Postoperative Drainage

“…In 1976, a study reported the use of TXA in orthopedic treatment to reduce bleeding in patients [ 20 ]. Recent literature confirms that surgical trauma leads to the release of tissue-type fibrinogen activators, which degrades fibrin and multiple coagulation factors, decreasing their plasma levels and activity [ 21 ]. The mechanism of action of TXA is to prevent fibrin degradation by fibrinolytic enzymes.…”

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

“…Exclusion criteria were determined by TXA contraindications in drug information literature. 1 In addition to patients with an allergy to TXA and impaired renal function, patients at highest risk of venous or arterial thrombotic disease were excluded. This category includes patients with a history of a vascular event within the last year or active malignancy.…”

“…If medically cleared, all patients were taken to the operating room within 24 hours of admission. 1 For patients that were eligible for the 4-dose regimen but had not received the initial admission TXA doses, due to either protocol deviations, misunderstandings by different care teams, or random errors, all these patients were still given 1-g of TXA at the time of surgical incision followed by 1 g 3 hours later. Similarly, there were patients that were deemed ineligible for the 4-dose TXA protocol due to the aforementioned contraindicated comorbidities, but some respective care teams proceeded with an abbreviated two-dose TXA of 1-gram of TXA at the time of surgical incision followed by 1 g 3 hours later for these patients.…”

“… 1 - 3 , 7 , 9 As allogenic blood transfusions have been associated with increased risks of transfusion reactions, length of hospital stay, infection transmission, and costs, recent clinical recommendations have endorsed the use of TXA in other areas orthopaedic surgery. 1 - 3 , 9 …”

“…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.…”