A Single Dose Versus Two Doses of Tranexamic Acid for Extracapsular Hip Fractures

Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.

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Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose

Journal of Orthopaedic Surgery ◽

10.1177/2309499019880915 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901988091 ◽

Cited By ~ 1

Author(s):

Gopalan Balachandar ◽

Tarek Abuzakuk

Keyword(s):

Total Knee Arthroplasty ◽

Single Dose ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Optimal Timing ◽

Bilateral Total Knee Arthroplasty ◽

Allogenic Transfusion ◽

Duration Of Surgery ◽

Total Knee

Purpose: There is no consensus on the optimum timing of administration of tranexamic acid (TA) in bilateral total knee arthroplasty (TKA). We aimed to determine whether the timing of administration of single-dose intravenous TA (either given preoperatively or intraoperatively) has a significant effect on blood loss reduction. Methods: We compared two cohorts of patients with end-stage arthritis of knees who underwent bilateral TKA and were given single-dose intravenous TA (1 g or 15 mg/kg) at different times during surgery. The retrospective cohort group consisting of 40 patients (preoperative (PO) group) received TA before the skin incision. The prospective cohort consisting of 40 patients (intraoperative (IO) group) received TA 10 min before deflating the tourniquet on the first knee. Primary outcome measures were mean hemoglobin difference, A (between PO and day 1 postoperative hemoglobin), mean hemoglobin difference, B (between PO and lowest postoperative hemoglobin), and rate of allogeneic blood transfusion. Secondary measure was drain blood loss. Results: Both cohorts were well matched with respect to age, gender, duration of surgery, and length of hospital stay. The hemoglobin drop in the IO group was significantly lesser than the PO group on the first postoperative day (2 vs. 2.9 g/dL, p < 0.001). Although statistically insignificant, the patients in the IO group received less allogenic transfusion of packed cell units than in the PO group (11/40, 27.5% vs. 14/40, 35% ). Mean hemoglobin difference, B, and secondary drain loss were comparable in both groups. Conclusion: Single-dose intravenous TA given before the start of surgery is as effective as a dose given during arthroplasty of the first knee in reducing blood loss in bilateral TKA.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1288.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 442-448

Author(s):

Vasileios S. Nikolaou ◽

Panagiotis Masouros ◽

Themistoklis Floros ◽

Efstathios Chronopoulos ◽

Maria Skertsou ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Single Dose ◽

Hip Fracture ◽

Blood Loss ◽

Elderly Patients ◽

Tranexamic Acid ◽

Controlled Trial ◽

Total Blood ◽

Subcapital Fracture ◽

Randomized Controlled

Aims The aim of this study was to investigate the hypothesis that a single dose of tranexamic acid (TXA) would reduce blood loss and transfusion rates in elderly patients undergoing surgery for a subcapital or intertrochanteric (IT) fracture of the hip. Methods In this single-centre, randomized controlled trial, elderly patients undergoing surgery for a hip fracture, either hemiarthroplasty for a subcapital fracture or intramedullary nailing for an IT fracture, were screened for inclusion. Patients were randomly allocated to a study group using a sealed envelope. The TXA group consisted of 77 patients, (35 with a subcapital fracture and 42 with an IT fracture), and the control group consisted of 88 patients (29 with a subcapital fracture and 59 with an IT fracture). One dose of 15 mg/kg of intravenous (IV) TXA diluted in 100 ml normal saline (NS,) or one dose of IV placebo 100 ml NS were administered before the incision was made. The haemoglobin (Hb) concentration was measured before surgery and daily until the fourth postoperative day. The primary outcomes were the total blood loss and the rate of transfusion from the time of surgery to the fourth postoperative day. Results Homogeneity with respect to baseline characteristics was ensured between groups. The mean total blood loss was significantly lower in patients who received TXA (902.4 ml (-279.9 to 2,156.9) vs 1,226.3 ml (-269.7 to 3,429.7); p = 0.003), while the likelihood of requiring a transfusion of at least one unit of red blood cells was reduced by 22%. Subgroup analysis showed that these differences were larger in patients who had an IT fracture compared with those who had a subcapital fracture. Conclusion Elderly patients who undergo intramedullary nailing for an IT fracture can benefit from a single dose of 15 mg/kg TXA before the onset of surgery. A similar tendency was identified in patients undergoing hemiarthroplasty for a subcapital fracture but not to a statistically significant level. Cite this article: Bone Joint J 2021;103-B(3):442–448.

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Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds — a double blind randomised controlled trial

Burns ◽

10.1016/j.burns.2021.08.021 ◽

2021 ◽

Author(s):

Ajai K.S. ◽

Parmod Kumar ◽

Mohsina Subair ◽

Ramesh Kumar Sharma

Keyword(s):

Single Dose ◽

Randomised Controlled Trial ◽

Blood Loss ◽

Tranexamic Acid ◽

Controlled Trial ◽

Double Blind ◽

Burn Wounds ◽

Randomised Controlled

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Single-dose tranexamic acid for reducing bleeding and transfusions in total hip arthroplasty: A double-blind, randomized controlled trial of different doses

Thrombosis Research ◽

10.1016/j.thromres.2016.02.027 ◽

2016 ◽

Vol 141 ◽

pp. 119-123 ◽

Cited By ~ 24

Author(s):

Changde Wang ◽

Pengde Kang ◽

Jun Ma ◽

Chen Yue ◽

Jinwei Xie ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Single Dose ◽

Total Hip Arthroplasty ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Controlled Trial ◽

Double Blind ◽

Total Hip ◽

Randomized Controlled ◽

Different Doses

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Intravenous Tranexamic Acid Decreases Blood Transfusions and Blood Loss for Patients with Surgically Treated Hip Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211063668 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110636

Author(s):

Phuong Anh N Huynh ◽

Megan Miller ◽

Ryan Will

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Risk Reduction ◽

Hip Fractures ◽

Absolute Risk ◽

Blood Transfusions ◽

Total Blood ◽

Allogenic Blood ◽

Operative Care ◽

Decrease Blood Loss

Introduction Tranexamic acid can decrease blood loss related to surgery and trauma. The primary objective of this study is to examine if the use of a single dose of peri-operative TXA significantly decreases the rate of allogenic blood transfusions in the setting of operative care of hip fractures. Secondary objectives included examining if total blood loss was decreased by TXA in operative hip fractures as well as examining the safety of TXA by measuring the rates venous thromboembolism (VTE). Methods Retrospective chart review of 505 patients who were operatively treated for hip fractures at a single facility was performed. In a non-randomized fashion, 307 patients received TXA and 198 patients did not. Patients received 1 gram of TXA prior to incision. Blood transfusion was the primary end point. Blood loss was calculated using the hemoglobin balance method. Chart was reviewed for VTE events during hospitalization. Results 505 patients were analyzed. The use of single perioperative dose of TXA in the surgical management of hip fracture resulted in absolute risk reduction of transfusion of 7.7% and relative risk reduction of transfusion by 29%. This was statistically significant with P =.04. Patients who received TXA on average lost 235 ml less blood compared to those who did not receive TXA ( P <.0001). No increase in VTE events were found in either group during hospitalization. Conclusion This study supports the use of TXA is decrease blood loss and transfusion rates in patients with hip fractures. TXA can be used routinely to decrease complications in this usually fragile population.

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