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Blumenthal SR, Fryhofer GW, Stein MK, Zhang SE, Looby S, Mehta S. Variable Efficacy of Tranexamic Acid in Geriatric Hip Fractures Treated With Arthroplasty Versus Cephalomedullary Nails. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00006. [PMID: 39121795 PMCID: PMC11319306 DOI: 10.5435/jaaosglobal-d-24-00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Geriatric hip fractures are associated with high rates of disability and mortality. Many of these patients require perioperative and postoperative allogeneic blood transfusions, which carry several noteworthy risks. A growing body of literature supports the efficacy of tranexamic acid (TXA) in geriatric hip fractures, without sufficient data examining which subgroups are likely to benefit the most. METHODS In this study, we sought to evaluate whether TXA was associated with reduced blood loss and transfusions in a geriatric population undergoing hip fracture fixation at our institution during a 2-year period. The first year's data were collected in a retrospective fashion before the introduction of a quality control initiative encouraging TXA administration for all geriatric hip fractures. The second year's data were collected prospectively. A subgroup analysis was conducted for patients who underwent arthroplasties. RESULTS Among the pooled cohort of patients undergoing surgery, TXA showed no benefit over control subjects for reducing blood loss or transfusion requirements. However, the subgroup of patients undergoing arthroplasty procedures showed a notable decrease in total blood loss and total units transfused during hospitalization. DISCUSSION These results suggest that TXA may be most beneficial when targeted to arthroplasties performed for geriatric hip fractures.
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Affiliation(s)
- Sarah R. Blumenthal
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
| | - George W. Fryhofer
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
| | - Matthew K. Stein
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
| | - Steven E. Zhang
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
| | - Sean Looby
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
| | - Samir Mehta
- From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (Dr. Blumenthal, Dr. Fryhofer, Dr. Stein, Dr. Zhang, Mr. Looby, Dr. Mehta), and the Department of Orthopaedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA (Dr. Blumenthal)
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Farhan-Alanie MM, Chinweze R, Walker R, Eardley WGP. The impact of anticoagulant medications on fragility femur fracture care: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study. Injury 2024; 55:111451. [PMID: 38507942 DOI: 10.1016/j.injury.2024.111451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/17/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Due to their hypocoagulable state on presentation, anticoagulated patients with femoral fragility fractures typically experience delays to surgery. There are no large, multicentre studies previously carried out within the United Kingdom (UK) evaluating the impact of anticoagulant use in this patient population. This study aimed to evaluate the current epidemiology and compare the perioperative management of anticoagulated and non-anticoagulated femoral fragility fracture patients. METHODS Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the United Kingdom. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Main outcomes under investigation included time to surgery, receipt of blood transfusion between admission and 48 h following surgery, length of stay, and 30-day mortality. These were assessed using multivariable linear and logistic regression, and Cox proportional hazards models. Only data from hospitals ≥90 % case ascertainment with reference to figures from the National Hip Fracture Database (NHFD) were analysed. RESULTS Data on 10,197 patients from 78 hospitals were analysed. 18.5 % of patients were taking anticoagulants. Compared to non-anticoagulated patients, time to surgery was longer by 7.59 h (95 %CI 4.83-10.36; p < 0.001). 42.41 % of anticoagulated patients received surgery within 36 h (OR 0.54, 95 %CI 0.48-0.60, p < 0.001). Differences in time to surgery were similar between countries however there was some variation across units. There were no differences in blood transfusion and length of stay between groups (OR 1.03, 95 %CI 0.88-1.22, p = 0.646 and 0.22 days, 95 %CI -0.45-0.89; p = 0.887 respectively). Mortality within 30 days of admission was higher in anticoagulated patients (HR 1.27, 95 %CI 1.03-1.57, p = 0.026). CONCLUSIONS Anticoagulated femoral fragility fracture patients comprise a substantial number of patients, and experience relatively longer delays to surgery with less than half receiving surgery within 36 h of admission. This may have resulted in their comparatively higher mortality rate. Inclusion of anticoagulation status in the minimum data set for the NHFD to enable routine auditing of performance, and development of a national guideline on the management of this growing and emerging patient group is likely to help standardise practice in this area and improve outcomes.
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Affiliation(s)
- M M Farhan-Alanie
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - R Chinweze
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA2 7HY, UK
| | - R Walker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BY, UK
| | - W G P Eardley
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BY, UK; University of Teesside, Middlesbrough, TS1 3BX, UK; University of York, York, YO10 5DD, UK
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Yakel S, Than J, Sharp J, Coskey O, Den H, Krumrey J. The Efficacy of Tranexamic Acid for Reducing Blood Transfusion Rates in Extracapsular Hip Fractures: A Single-Center Randomized Controlled Trial. Orthopedics 2023; 46:e303-e309. [PMID: 36853931 DOI: 10.3928/01477447-20230224-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Perioperative allogenic blood transfusions for patients with hip fractures are associated with increased costs and complications. This prospective randomized controlled trial evaluated whether tranexamic acid (TXA) reduces blood transfusion rates and blood loss in extracapsular hip fractures, when administered at the time of hospital admission. Patients with closed intertrochanteric or subtrochanteric femur fractures undergoing intramedullary nailing (n=100) were enrolled from October 2015 to January 2019. On arrival to the hospital, patients were randomized to receive either 1 g of intravenous TXA or normal saline. Blood transfusion rates from hospital arrival to postoperative day 5 or discharge, blood loss from hospital arrival to postoperative day 3 or 4, intraoperative blood loss, length of hospital stay, 30-day mortality, and major complications were evaluated. Six patients from the TXA group and five from the placebo group were excluded because of canceled surgery, study drug infusion after incision, multiple fractures, or dropout. Patient characteristics were similar between the groups. Postoperative transfusion rates were 17.5% (7 of 40) in the TXA group and 36.7% (18 of 49) in the placebo group (relative risk, 0.48; 95% CI, 0.22-1.03; P=.046). Total blood loss was significantly less in the TXA group (mean difference, 367 mL; 95% CI, 76-657; P=.01). No significant differences were found for intraoperative blood loss, length of hospital stay, 30-day mortality, or 30-day major complications. TXA administered on hospital arrival decreased the risk of postoperative blood transfusion and mean perioperative blood loss in patients with extracapsular hip fractures. We recommend a single-dose intravenous administration of TXA at the time of hospital admission for patients with extracapsular hip fractures. [Orthopedics. 2023;46(5):e303-e309.].
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Lam KM, Hsu YC. A retrospective cohort study of the effect of intravenous tranexamic acid infusion on geriatric hip fractures patients undergoing proximal femoral nail antirotation. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917231161831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Tranexamic acid (TXA) has been used in the management of bleeding. We are conducting a retrospective cohort study to analyse the effect of intravenous TXA infusion on the surgical outcomes of geriatric hip fracture cases which undergoes proximal femoral nail antirotation. Methods: In this study, 364 patients who had undergone proximal femoral nail antirotation between January 2018 and December 2019 in United Christian Hospital have been recruited. Two-hundred thirteen patients were recruited in controlled group and 151 patients were recruited in TXA group. One gram of TXA acid was injected intravenously on induction of anaesthesia and before surgical incision. Outcomes including length of stay, operation time, intraoperative blood loss, haemoglobin and haematocrit drop and post-operative blood transfusion have been measured. Results: There was a reduction in operative time, intraoperative blood loss, post-operative haemoglobin and haematocrit drop and post-operative blood transfusion in TXA group, with a reduction in the intraoperative blood loss (Controlled group: 97.8 ± 67.7 ml, TXA group: 76.0 ± 71.4, Difference −22.3%, p-value: 0.0036) and post-operative haematocrit drop (Controlled group: 0.04 ± 0.03, TXA group: 0.03 ± 0.03, Difference −25%, p-value: 0.05) being statistically significant. The length of stay is not statistically significant between the two groups. TXA is an antifibrinolytic agent which acts by binding to plasminogen which inhibits plasma formation. It has a potential reduction in blood loss in major operations. Conclusion: Intravenous TXA infusion helps to reduce blood loss in a patient undergoing proximal femoral nail antirotation. It is safe to use in the geriatric group of patients. We would recommend the usage of TXA infusion to improve the surgical outcome.
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Affiliation(s)
- Ka Mun Lam
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong
| | - Yung Chak Hsu
- Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong
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Levack AE, Moore HG, Stephan SR, Jo S, Schroeder IG, Garlich JM, Hadad A, Little MT, Miller AN, Lyman S, Lane JM. Chronic Warfarin Anticoagulation in Hip Fracture Patients Delays Surgery and Is Associated With Increased Risk of Postoperative Complications: A Multicenter Propensity-Score-Matched Analysis. J Orthop Trauma 2023; 37:57-63. [PMID: 36048739 PMCID: PMC9868061 DOI: 10.1097/bot.0000000000002484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the effect of warfarin on blood transfusion and postoperative complications in a low-energy hip fracture population compared with a non-anticoagulated comparison group. DESIGN Multicenter Retrospective Cohort. SETTING Three Urban Level I Academic Trauma Centers. PATIENTS Acute, low-energy, native hip fractures in patients 55 years of age or older on chronic warfarin anticoagulation, propensity score matched 1:2 to non-anticoagulated hip fracture patients meeting all other inclusion criteria. MAIN OUTCOME MEASUREMENTS Transfusion and postoperative complication rates. RESULTS Two hundred ten anticoagulated hip fracture patients were matched to 420 nonanticoagulated patients. A higher proportion of patients required blood transfusion in the warfarin cohort (52.4% vs. 43.3%, P < 0.001), attributable mostly to the subgroup of patients undergoing arthroplasty. Warfarin patients had higher incidence of overall 90-day complications (47% vs. 38%, P = 0.039) and readmissions (31.4% vs. 8.9%, P < 0.001). Day of surgery international normalized ratio (INR) did not influence transfusions or complications among warfarin patients. Warfarin patients undergoing surgery within 24 hours had no difference in transfusions and had fewer complications compared with those undergoing surgery after 24 hours. On multivariable logistic regression analysis, warfarin use and day of surgery INR were not predictors of transfusion or complications. CONCLUSIONS Patients on warfarin experienced longer time to surgery and higher incidence of overall transfusion and postoperative complications within 90 days of surgery. However, warfarin use and day of surgery INR was not independently associated with transfusions or complications. The reason for poorer outcomes in warfarin patients remains a topic of further investigation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ashley E. Levack
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Stephen R. Stephan
- Department of Orthopaedic Surgery, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Sally Jo
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian G. Schroeder
- Department of Orthopaedic Surgery, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - John M. Garlich
- Department of Orthopaedic Surgery, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Aidan Hadad
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA
| | - Milton T.M. Little
- Department of Orthopaedic Surgery, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Anna N. Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen Lyman
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Joseph M. Lane
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA
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Intravenous Tranexamic Acid Given at Femoral Fragility Fracture Surgery Reduces Blood Transfusion Requirements Fourfold. World J Surg 2023; 47:912-921. [PMID: 36725742 PMCID: PMC9971041 DOI: 10.1007/s00268-022-06886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 02/03/2023]
Abstract
AIMS This study aims to determine whether intraoperative intravenous (IV) tranexamic acid (TXA) affects blood loss following the surgical management of femoral fragility fractures (FFF). METHODS This was a single centre (university teaching hospital) non-randomised case-control study. There were 361 consecutive patients with FFF admitted over a 4-month period were included (mean age 81.4yrs; mean BMI 23.5; 73.7% female). Patient demographics, comorbidities, preoperative anticoagulation use, surgical management, intravenous TXA use, perioperative haemoglobin (Hb) and haematocrit, and requirement for blood transfusion were recorded. The primary outcome was postoperative blood transfusion requirement. Secondary outcomes included postoperative day one calculated blood loss (CBL) (using the Nadler and Gross formulae) and fall in Hb (percentage) from preoperative levels; and the incidence of thrombotic events and mortality up to 30 days. RESULTS Groups were well matched in terms of patient demographics, comorbidities, preoperative anticoagulation use, injury types and surgical management. Intravenous TXA 1 g given at the beginning of surgery at the discretion of the operating team: 178 (49%) received TXA and 183 (51%) did not. The requirement for postoperative blood transfusion was significantly less in the TXA group: 15/178 (8.4%) compared to 58/183 (31.7%) (p < 0.001; Chi square). TXA significantly reduced both the percentage fall in Hb (mean difference 4.3%, p < 0.001) and the CBL (mean difference -222 ml, p < 0.001). There was no difference in VTE (2 vs 1, p = 0.620) or other thrombotic events (2 vs 0, p = 0.244) between groups. CONCLUSION 1 g of intraoperative intravenous TXA during the surgical management of FFF was associated with reduced rate of transfusion, CBL and the percentage drop in HB. The use of TXA in this study was not randomised, so there could be un-quantifiable bias in the patient selection.
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Augustinus S, Mulders MAM, Gardenbroek TJ, Goslings JC. Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 49:1247-1258. [DOI: 10.1007/s00068-022-02180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
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Agius C, Cole E, Mifsud MG, Vasireddy A. The Use of Tranexamic Acid in Hip Fracture Surgery-A Systematic Review and Meta-analysis. J Orthop Trauma 2022; 36:e442-e448. [PMID: 36399681 DOI: 10.1097/bot.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze the effect of intravenous tranexamic acid (TXA) on blood transfusion requirements in adult patients undergoing hip fracture surgery. Secondary aim was to evaluate the safety by assessing thromboembolic events. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, PubMed, and Embase were searched for randomized controlled trials published in English from 2010. STUDY SELECTION Studies eligible for inclusion were randomized controlled trials that analyzed the use of intravenous TXA on blood transfusion requirement in hip fracture surgery. DATA EXTRACTION Titles and abstracts were screened and assessed for eligibility by 2 independent reviewers. Quality and risk of bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach and the Cochrane risk-of-bias tool (RoB2). DATA SYNTHESIS Meta-analysis with random and fixed effect models was performed. Risk ratio (RR) was calculated for dichotomous outcomes and estimated with a 95% confidence interval (CI). For continuous data, the risk difference (RD) was estimated with a 95% CI. RESULTS A total of 13 trials involving 1194 patients were included. Pooled results showed that patients in the TXA group had significantly lower transfusion requirements (RR 0.50, 95%CI 0.30-0.84, P = 0.009). Similar findings were observed in the subcohort of patients with transfusion threshold of Hb < 8g/dL, (RR 0.42, 95%CI 0.31-0.56, P < 0.0001). This risk reduction was not observed in the subcohort of patients with transfusion threshold of Hb 8.1-10g/dL who received TXA (RR 0.77, 95%CI 0.51-1.18, P = 0.23) and no statistically significant differences were found for total thromboembolic events (RR 0.01, 95%CI -0.02-0.04, P = 0.47). CONCLUSION This meta-analysis demonstrated that intravenous TXA reduced blood transfusion rates and did not increase the risk of thromboembolic events. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christabel Agius
- Department of Orthopaedic Surgery, Trauma & Sports Medicine, Mater Dei Hospital, Msida, Malta
- Blizard Institute, Queen Mary University of London, London, United Kingdom; and
| | - Elaine Cole
- Blizard Institute, Queen Mary University of London, London, United Kingdom; and
| | - Mary Grace Mifsud
- Department of Orthopaedic Surgery, Trauma & Sports Medicine, Mater Dei Hospital, Msida, Malta
| | - Aswinkumar Vasireddy
- Blizard Institute, Queen Mary University of London, London, United Kingdom; and
- Department of Trauma and Orthopaedic Surgery, King's College Hospital, London, United Kingdom
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van Rijckevorsel VAJIM, Roukema GR, Kuijper TM, de Jong L. Clinical outcomes of tranexamic acid in acute hip hemiarthroplasties in frail geriatric patients. Orthop Traumatol Surg Res 2022; 108:103219. [PMID: 35093562 DOI: 10.1016/j.otsr.2022.103219] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) has shown to significantly reduce perioperative blood loss in elective orthopedic joint replacement surgery but is yet not implemented in acute hip fracture surgery for elderly patients who are particularly vulnerable to perioperative blood loss and postoperative anemia. Aim of this study is to answer the following questions: 1. Does TXA reduce bleeding associated complications in elderly patients? 2. Does TXA induce thromboembolic complications in elderly patients? HYPOTHESIS TXA reduces perioperative blood loss and associated complications in acute hip fracture surgery in geriatric patients. PATIENTS AND METHODS In this observational cohort study with prospectively enrolled patients over 65 years of age who received an acute hip hemiarthroplasty, the primary outcome was blood loss, also described as Δ hemoglobin. Secondary outcomes were bleeding associated complications as hematomas. Also, the occurrence of thromboembolic events and mortality were examined. RESULTS In total 864 geriatric patients were included of which 235 received TXA and 629 did not. Multivariable analysis showed reduced Δ hemoglobin loss [-0.24 (-0.39; -0.09), p=0.002] and hematomas (OR 0.44 (0.21; 0.91), p=0.026). Pulmonary embolism were diagnosed more frequently after administration of TXA (2% versus 0.3%, p=0.008), without an association with increased 30-day mortality rate (6% versus 8%, p=0.3). DISCUSSION TXA reduced perioperative blood loss and associated complications. However, adverse effects of TXA as pulmonary embolisms were found more frequently without effecting postoperative mortality rates. More research is needed to assess adverse effects of intravenous TXA and topical TXA as an alternative for systemic TXA to prevent systemic adverse effects. LEVEL OF EVIDENCE III, Observational cohort study.
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Affiliation(s)
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
| | - Tjallingius M Kuijper
- Maasstad Academy, statistician, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
| | - Louis de Jong
- Surgery Department, Franciscus Hospital, 3045 PM Rotterdam, the Netherlands
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Viberg B. Tranexamic Acid: When is It Indicated in Orthopaedic Surgery? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34902870 DOI: 10.1055/a-1666-9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tranexamic acid (TXA) has been studied extensively during the last 5-8 years. It inhibits clot dissolution during surgery and can therefore reduce blood loss. However, there has been concern that this could result in more frequent complications, specifically in terms of thromboembolic events. The indications for TXA are widespread, and this review covers the literature on orthopaedic indications such as joint replacement, fracture surgery, and arthroscopic procedures. In general, TXA is safe and can be used in a wide variety of orthopaedic procedures, lowering blood loss without increasing the risk of complications.
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Affiliation(s)
- Bjarke Viberg
- Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark.,Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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