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

Nikolaou, Vassilios S.; Masouros, Panagiotis; Floros, Themistoklis; Chronopoulos, Efstathios; Skertsou, Maria; Babis, George C.

doi:10.1302/0301-620x.103b3.bjj-2021-0172

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…Seventy-seven patients with intertrochanteric fractures were randomized to receive either placebo or IV TXA preoperatively. In a similar, yet larger, randomized controlled trial, Nikolaou et al 20 demonstrated a significant reduction in transfusion rates and blood loss among 165 patients with femoral neck and intertrochanteric fractures receiving IV TXA versus placebo. Our study is the first, to our knowledge, to look specifically at locally injected TXA in a hip fracture cohort that includes intertrochanteric fractures.…”

Section: Discussionmentioning

confidence: 90%

“…The effectiveness demonstrated by locally injected TXA in our study is consistent with previous literature on the use of TXA in both hip fracture and total joint populations. 3,6,8,13,16,20 Blood loss was similar between groups, indicating locally injected TXA may have more of an effect on postoperative rather than intraoperative blood loss. We noted that on subgroup analysis, patients with trochanteric fracture had an 8% decrease in transfusion, which was not statistically significant, and patients with femoral neck fractures had an 11% decrease, which was significant.…”

Section: Discussionmentioning

confidence: 91%

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Efficacy and Safety of Locally Injected Tranexamic Acid in Hip Fracture Patients: A Retrospective Review

Witmer

Solomito

Kumar

et al. 2022

Journal of Orthopaedic Trauma

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Objective:To determine whether locally injected tranexamic acid (TXA) used in the surgical treatment of fragility hip fractures can lower transfusion rates without increasing the risk of complications.Design:Retrospective comparative cohort.Setting:Tertiary referral orthopaedic specialty hospital, Level I trauma center.Patients/Participants:A total of 490 patients (252 patients received TXA) 50 years of age and older who underwent surgery for a low-energy fragility fracture of the proximal femur between March 2018 and February 2020 were included in this study.Intervention:Use of locally injected TXA at the time of wound closure.Main Outcome:The main outcomes of this study were the number of patients requiring postoperative blood transfusions, incidences of venous thromboembolism, and surgical site infections.Results:A statistically significant difference was noted in the frequency of transfusion between patients who received TXA compared with those who did not receive TXA (33% vs. 43%, respectively) (P = 0.034). There were no significant differences in venous thromboembolism incidence (0.4% vs. 0.8% TXA vs. No TXA) (P = 0.526) or infections (0.4% vs. 0.4% TXA vs. No TXA) (P = 0.965). Regression analysis indicated that the use of TXA reduced the need for postoperative blood transfusion by 31% (odds ratio: 0.688, 95% CI: 0.477–0.993, P = 0.045).Conclusion:Locally injected TXA significantly reduced the need for postoperative transfusion in the surgical treatment of fragility hip fractures. In addition, there was no increased risk of complications in those receiving TXA versus those who did not. Locally injected TXA seems to be both a safe and effective way to reduce postoperative blood transfusions in patients with fragility hip fractures.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Efficacy and Safety of Locally Injected Tranexamic Acid in Hip Fracture Patients: A Retrospective Review

Witmer

Solomito

Kumar

et al. 2022

Journal of Orthopaedic Trauma

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“…The results of our study demonstrated that TXA use, whether Local or intravenously administered, provided significant reductions in transfusions during the postoperative period, consistent with previous studies in both hip fracture and total joint arthroplasty populations. 3,6,9,14,17,20 Lei et al 9 demonstrated a significant reduction in hidden blood loss and transfusions in a randomized controlled trial of patients receiving IV TXA for intertrochanteric fracture surgery. Similarly, Nikolaou et al 20 indicated that patients receiving IV TXA after a hip fracture had significantly reduced blood loss and transfusion requirements.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,9,14,17,20 Lei et al 9 demonstrated a significant reduction in hidden blood loss and transfusions in a randomized controlled trial of patients receiving IV TXA for intertrochanteric fracture surgery. Similarly, Nikolaou et al 20 indicated that patients receiving IV TXA after a hip fracture had significantly reduced blood loss and transfusion requirements. Our group has also previously published data on the Local TXA and control groups included in this study before our conversion to IV TXA.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][17][18][19] A more limited body of literature focusing on fragility hip fractures suggests that both locally injected (Local) and intravenous (IV) TXA can reduce blood loss and transfusions in fragility hip fracture patients. 9,20,21 These studies have compared the effects of TXA to a control group; our literature review shows that no studies have compared the efficacy of Local TXA to IV TXA within a fragility fracture population.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review

Davis,

Solomito,

Kumar

2024

Journal of Orthopaedic Trauma

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OBJECTIVE: Evaluate differences between blood transfusion and complication rates among fragility hip fracture patients treated with locally injected (Local) versus intravenous (IV) tranexamic acid (TXA). METHODS Design: Retrospective comparative cohort Setting: Tertiary referral orthopedic specialty hospital; Level I trauma center Patient Selection Criteria: Patients aged 50 years and over who underwent surgical treatment for a proximal femur fragility fracture (OTA/AO 31A and 31B). between March 2018 and April 2022 with or without the use of local TXA during wound closure or IV TXA. Outcome Measures and Comparisons: Post-operative blood transfusion, venous thromboembolism (VTE), surgical site infections (SSI), and 30-day readmissions compared between those who received IV TXA, Local TXA, and controls that did not receive any TXA. RESULTS: 746 patients (258 received IV TXA, 252 received Local TXA, and 236 control that did not receive any TXA) were studied. Both Local and IV TXA groups received fewer blood transfusion versus controls. IV TXA was associated with a transfusion rate reduction of 12% compared to Local TXA (p<0.001). Regression analysis indicated that IV TXA reduced the odds of a post-operative blood transfusion by 48% compared to Local TXA (p=0.017). There were no differences in complication rates among the groups; however, patients receiving IV TXA had a significantly lower 30-day readmission rate (5%) than the control (13.9%) or Local (13.8%) TXA groups (p=0.001). CONCLUSION: Intravenous TXA significantly reduced the risk of postoperative transfusion compared to controls and patients receiving Local TXA. There was no increased risk of complications, and a lower 30-day readmission was observed for the IV TXA group. IV TXA appears to be a safe and effective way to reduce post-operative blood transfusion in patients with fragility hip fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

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Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

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

Cited by 4 publications

References 5 publications

Efficacy and Safety of Locally Injected Tranexamic Acid in Hip Fracture Patients: A Retrospective Review

Efficacy and Safety of Locally Injected Tranexamic Acid in Hip Fracture Patients: A Retrospective Review

Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

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