Tranexamic Acid in the Treatment of Hip Fractures: A Clinical Review

Krebs, Nathan M; VanWagner, Michael J.; Marchewka, Tiffany; Faraj, Usama; Vitale, Christopher

doi:10.51894/001c.7026

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…32 As part of their reviews published in 2019 of the existing studies on TXA administration as part of treatment of hip fractures, Krebs et al and Qi et al were not able to find any studies in which there was a significant increase in the rate of thromboembolic events. 30,33 It was not possible to figure out a significant reduction in the incidence of post-operative renal failure in our patient population (nonTXA = 7.7%; TXA = 6.5%; P = .76). Cheung et al obtained the same result in their 2020 study, which evaluated U.S. registry data of 3812 patients who had received TXA as part of treatment for hip fractures: irrespective of TXA administration, they saw postoperative renal failure in 4.9% of cases.…”

Section: Discussionmentioning

confidence: 73%

“…Krebs et al included just one doubleblind study in their 2019 review, whereby 84 patients received preoperative TXA in this same scenario. 30 In this study from 2015, Lee et al provided evidence of a 13% reduction in transfusion rates in the TXA group, concluding that the use of TXA can be recommended as part of procedures for implantation of dual-head prostheses for femoral neck fracture. 23 In our retrospective study, we included 93 patients who received TXA as part of treatment for femoral neck fractures using a dual-head prosthesis.…”

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome

Wilharm

Wutschke

Schenk

et al. 2023

Geriatr Orthop Surg Rehabil

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Introduction: Implantation of a dual-head hip prosthesis to treat medial femoral neck fractures is often associated with significant blood loss. In elective endoprosthetics procedures, it has already been demonstrated that administration of tranexamic acid (TXA) reduces blood loss and need for postoperative transfusions, as well as reducing the frequency of postoperative complications. The aim of this study is to show whether the administration of TXA also leads to a reduction in perioperative blood loss and haemorrhage-associated complications when applied as part of treatment of femoral neck fractures using a dual-head prosthesis. Methods: In a single-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 93 patients who had suffered from femoral neck fractures. This group was compared to a comparison group of 65 patients who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, frequency of transfusion, and frequency of specific complications occurring. Results: The transfusion rate in the TXA group was 6% lower, whereby the volume of blood transfused was 26.7% lower than in the nonTXA group. However, neither result was significant. The calculated perioperative blood loss remained the same. Similarly, the incidence of postoperative renal failure was not significantly lower in the TXA group, at 6.5%, as compared to the nonTXA group (7.7%). A higher rate of complications or deaths as a result of TXA administration was not observed. The tranexamic acid effect seems to be related to the dose. Conclusion: Preoperative administration of TXA during implantation of a dual-head prosthesis for treatment of a femoral neck fracture does not lead to an increased complication rate. The study revealed a trend towards fewer transfusions required, but a significant reduction in blood loss could not be demonstrated. There should be further investigation of other factors influencing blood loss, in particular the dosing regimen followed for perioperative administration of TXA. Level of Evidence: Level 4: retrospective case-control study

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 86%

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Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome

Wilharm

Wutschke

Schenk

et al. 2023

Geriatr Orthop Surg Rehabil

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“…The other measures, particularly during the last quarter of the study from 2017-2021, are based on study results [16,17,18,21,22,23,24,31,32] which were implemented gradually. From our point of view, therefore, the years 2019-2021, in which all of the measures were routinely applied, can be considered to reflect a modern treatment regime.…”

Section: Strengths Of the Studymentioning

confidence: 99%

“…Die Autoren fanden durch diese Maßnahmen eine Reduktion der Majorkomplikationsrate um 60 % sowie eine Reduktion der operativen Revisionsrate von 12,6 % auf 4,9 % bei gleichbleibender Sterblichkeit. Vergleichend zu unserer Studie zeigt sich bei Lian et al [13] Die weiteren Maßnahmen, insbesondere im letzten Studiendrittel 2017-2021, basieren auf Studienergebnissen [16,17,18,21,22,23,24,31,32], die schrittweise umgesetzt wurden. Aus Sicht der Autoren können deshalb insbesondere die Jahre 2019-2021 mit routinemäßiger Anwendung aller Maßnahmen als modernes Therapieregime gewertet werden.…”

Section: Stärken Der Studieunclassified

Sind Prozessänderungen messbar? Eine Analyse über 16 Jahre mit 4163 proximalen Femurfrakturen

Müller,

Proske,

Füchtmeier

et al. 2024

Z Orthop Unfall

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Process changes in the perioperative setting are rarely analysed, as their results are not immediately tangible and require a high case volume. The primary objective of this study was to retrospectively evaluate process changes using proximal femur fractures (PFF) and to examine their effect using various outcome measures. The secondary objective was to define potential quality criteria for the management of PFF.This study included a retrospective analysis of the database of a level-1 trauma centre for PFF. All PFF treated with osteosynthesis and endoprosthesis during the treatment period from 1 January 2006 to 31 December 2021, were included. The 16-year period was trichotomously divided for statistical analysis, and the first 6 years were used as the baseline. A total of 10 process changes were implemented in the subsequent 10 years. The impact of these changes was assessed using operative revision rate, infection rate, perioperative transfusion rate, and 1-year mortality.A total of 4,163 PFF were analysed. Regarding the outcome measures, changes in the first 5 years (2012–2016; intramedullary procedures for osteosynthesis and use of disposable drape and gown) showed the most significant effect, with sustained reduction in long-term surgical revision rate of < 10%. Further process optimisations over the past 5 years (2017–2021) also yielded measurable improvements (reduction in infection and transfusion rates). The 1-year mortality remained unchanged, even during the COVID-19 pandemic.Process changes in PFF do not immediately lead to objectively measurable improvements. In retrospect, the paradigm shift from extra- to intramedullary osteosynthesis appears to have the greatest effect, although gradual improvements were noted in all outcome measures over the past 10 years, except for mortality. An objective quality control target should aim for a 1-year revision rate of < 10%.

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Relation of tranexamic acid therapy to length of stay in the hip fracture population

Oguayo

Helal

Dawkins

et al. 2022

Baylor University Medical Center Proceedings

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Tranexamic Acid in the Treatment of Hip Fractures: A Clinical Review

Cited by 4 publications

References 23 publications

Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome

Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome

Sind Prozessänderungen messbar? Eine Analyse über 16 Jahre mit 4163 proximalen Femurfrakturen

Relation of tranexamic acid therapy to length of stay in the hip fracture population

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