A prospective randomized control trial of topical tranexamic acid used in elderly patients with femoral neck fractures treated with hemiarthroplasty
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20230286Keywords:
Tranexamic acid, Perioperative blood loss, Hemiarthroplasty, Topical tranexamic acidAbstract
Background: Geriatric hip fracture patients frequently suffer femoral neck injuries. The advantage of using TXA topically over the IV route is that maximum concentration of the drug is attained at the wound/surgical site with minimal systemic side effects of drug and also it is easy to administer locally. Aim of current study was fragmented necks of the femur can be treated with Tranexamic acid to reduce postoperative blood loss.
Methods: Over the course of 20 months from June 2020 to December 2021, the orthopaedics department at SMS Hospital, Jaipur, conducted this study. A total of 174 patients (87 in each group) of age >60 years, presenting with neck of the femur in orthopaedics wards were enrolled in this study.
Results: Compared to the control group, the case group experienced 408 ml more blood loss, which was treated with tranexamic acid. In cases and controls, transfusion was necessary for 31 and 41 patients, respectively.
Conclusions: One dosage of topical tranexamic acid may be given to an older patient undergoing bipolar hemiarthroplasty for a fractured femoral neck in order to minimize post-operative blood loss.
References
Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a worldwide projection. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 1992;2(6):285-9.
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 1997;7(5):407-13.
Hongisto MT, Pihlajamäki H, Niemi S, Nuotio M, Kannus P, Mattila VM. Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011. Int Orthop. 2014;38(8):1685-90.
Flohé S, Kobbe P, Nast-Kolb D. Immunological reactions secondary to blood transfusion. Injury. 2007; 38(12):1405-8.
Johansson T, Pettersson L, Lysander B. Tranexamic acid in total hip arthroplasty saves blood and money. Acta Orthop. 2005;76(3):314-9.
Benoni G, Fredin H, Knebel R, Nilsson P. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand. 2001;72(5): 442-8.
Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2): 224-32.
Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin. 1996;13(8):465-78.
Innerhofer P, Klingler A, Klimmer C, Fries D, Nussbaumer W. Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopaedic patients undergoing primary arthroplasty. Transfusion. 2005; 45(1):103-10.
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008; 466(7):1710-5.
Nishihara S, Hamada M. Does tranexamic acid alter the risk of thromboembolism after total hip arthroplasty in the absence of routine chemical thromboprophylaxis? Bone Joint J. 2015;97-B(4):458-62.
Myers SP, Kutcher ME, Rosengart MR, Sperry JL, Peitzman AB, Brown JB, et al. Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism. J Trauma Acute Care Surg. 2019;86(1):20-7.
Thipparampall AK, Gurajala I, Gopinath R. The effect of different dose regimens of tranexamic acid in reducing blood loss during hip surgery. Indian J Anaesth. 2017;61(3):235-9.
Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, et al. The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018;32(3):165-78.
Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013; 28(9):1473-6.
Yue C, Kang P, Yang P, Xie J, Pei F. Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty. 2014;29(12):2452-6.
Kang JS, Moon KH, Kim BS, Yang SJ. Topical administration of tranexamic acid in hip arthroplasty. Int Orthop. 2017;41(2):259-63.
Tranexamic acid and thrombosis. Prescrire Int. 2013; 22(140):182-3.
Lee C, Freeman R, Edmondson M, Rogers BA. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: An observational cohort study. Injury. 2015;46(10):1978-82.