Use of tranexamic acid is not associated with complications following bipolar hemiarthroplasty for metastatic disease

Abstract

Introduction Advances in the care of cancer patients have resulted in increased survival. The proximal femur is a common site for metastatic disease, often requiring surgical intervention. Tranexamic acid (TXA) has proven to be safe in elective and traumatic femoral hemiarthroplasty; however, its use has not been investigated in oncologic patients. Method We reviewed 66 patients (37 males) with a mean age of 64 ± 3 years undergoing a hemiarthroplasty for metastatic disease in the femoral neck. A total of 22 (33%) patients received intraoperative TXA. Primary outcomes included postoperative blood loss, intraoperative and postoperative transfusion requirement, and postoperative complications. Results There was no difference in the baseline characteristics between the TXA and non‐TXA groups. When comparing the TXA and non‐TXA groups, there were no differences in 72 h postoperative blood loss between groups (1.21 L vs. 1.33 L, p = 0.61), percentage of patients requiring transfusion (36.4% vs. 36.4%, p = 1.0), or the incidence of postoperative complications including venous thromboembolism (14% vs. 11%, p = 0.70) and pulmonary embolism (0% vs. 5%, p = 1.0). Conclusion Oncology patients are a high‐risk population for thromboembolic events. This initial study supports the safe use of TXA intraoperatively in femoral hemiarthroplasty performed for metastatic disease.

Incidence of and Risk Factors for Thromboembolism After Endoprosthetic Reconstruction in Musculoskeletal Oncology Patients

“…The intraoperative use of TXA was not associated with a greater incidence of thromboembolic events, which is in line with the findings of a number of recent investigations and may justify the continued adoption of this drug in the musculoskeletal oncology population [5][6][7] . However, TXA did not reduce the rate of reoperation for irrigation and debridement, and therefore may not entirely mitigate postoperative hematoma and subsequent infection.…”

“…oncology population, and with some reservation [5][6][7] . Although the hypercoagulability of patients with tumors may justify this reservation, TXA may reduce the need for blood transfusions and, potentially, the postoperative formation of hematoma substantially enough to prevent a return to the operating room 6,7 .…”

“…Consensus regarding the risk factors associated with perioperative VTE in musculoskeletal oncology patients, or the preferred perioperative chemical thromboprophylaxis regimen, remains to be reached. Furthermore, the use of topical or intravenous tranexamic acid (TXA) intraoperatively, although established as commonplace across other orthopaedic subspecialties, has only recently been adopted in the musculoskeletal oncology population, and with some reservation 5-7 . Although the hypercoagulability of patients with tumors may justify this reservation, TXA may reduce the need for blood transfusions and, potentially, the postoperative formation of hematoma substantially enough to prevent a return to the operating room 6,7 .…”

Efficacy and Safety of Tranexamic Acid in Cancer Surgery. An Update of Clinical Findings and Ongoing Research

“…Haase et al 61 for example, found that topical TXA can reduce perioperative blood loss, transfusion rates, hospitalization, and VTE occurrence. Differently, Owen et al 62 did not show a reduction in blood loss and in blood transfusions when intravenous TXA was administrated before bipolar hemiarthroplasty for metastatic disease and at the time of closure. However, this study was conducted on a small and heterogeneous cohort of patients.…”

“…Differently, Owen et al 62 did not show a reduction in blood loss and in blood transfusions when intravenous TXA was administrated before bipolar hemiarthroplasty for metastatic disease and at the time of closure. However, this study was conducted on a small and heterogeneous cohort of patients.…”