title: The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study.
abstract: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective lower limb arthroplasty surgery. There are potentially even greater physiological benefits in minimising blood loss in hip fracture surgery, however limited evidence exists for TXA use in hemiarthroplasty surgery. This study investigates the effect of TXA use on postoperative transfusion rates and haemoglobin (Hb) levels specifically following hemiarthroplasty surgery for hip fractures. A retrospective cohort study was conducted for consecutive hip hemiarthroplasties for fractures between June 2013 and October 2014 comparing patients with or without prophylactic TXA before incision. During the study, 305 hemiarthroplasties were performed with 271 cases eligible. TXA was given in 84 (31%) cases, and both patient groups were matched for known confounding factors. Patients given TXA had a lower transfusion rate (6% vs. 19%. p=0.005) and less blood loss (Hb drop>20g/L) on day 1 post surgery (26% vs. 42%; p=0.014). One transfusion was prevented with every 8 patients given prophylactic TXA. There were no differences in the 30 and 90-day mortality rates with TXA use. Tranexamic acid is safe, cost-effective and reduces the need for blood transfusion and should be considered in all patients undergoing hip hemiarthroplasty for fractures.
authors.affiliation: Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK. Electronic address: drconradlee@gmail.com.
authors.forename: Conrad
authors.initials: C
authors.lastname: Lee
authors.affiliation: Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Freeman
authors.affiliation: Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Edmondson
authors.affiliation: Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton Sussex University Hospital Trust, Eastern Road, Brighton BN2 5BE, East Sussex, UK.
authors.forename: Benedict A
authors.initials: BA
authors.lastname: Rogers
mesh_terms: D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects; D006620:Hip Fractures / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Antifibrinolytic; Blood loss; Blood transfusion; Haemoglobin; Hip fracture; Hip hemiarthroplasty; Neck of femur fracture; Orthopaedic; Tranexamic acid; Trauma