RT Journal Article
SR Electronic
T1 Topical tranexamic acid in hip fractures: a randomized, placebo-controlled double-blinded study
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP E449
OP E456
DO 10.1503/cjs.014220
VO 64
IS 4
A1 Darren Costain
A1 Graham Elder
A1 Brian Fraser
A1 Brad Slagel
A1 Adrienne Kelly
A1 Yifun Cheong
A1 Luke Fera
YR 2021
UL http://canjsurg.ca/content/64/4/E449.abstract
AB Background: Tranexamic acid (TXA) has been shown to reduce perioperative blood loss in elective orthopedic surgery. The safety of intravenous TXA in nonelective hip fracture surgery is uncertain. The purpose of this study was to evaluate the efficacy and safety of topical TXA in hip fracture surgery.Methods: Adult patients presenting to a community hospital with a hip fracture requiring surgery were randomly assigned to receive topical TXA or placebo. Hemoglobin and troponin I levels were measured preoperatively and on postoperative days 1, 2 and 3. All postoperative blood transfusions were recorded. Complications, including acute coronary syndrome (ACS), venous thromboembolism (VTE), cerebrovascular accidents (CVA), surgical site infections (SSI) and 90-day mortality, were recorded.Results: Data were analyzed for 65 patients (31 in the TXA group, 34 in the control group). Hemogloblin level was significantly higher on postoperative days 1 and 2 in the TXA group than in the control group. The difference in hemoglobin level between the groups was not statistically significant by postoperative day 3. Significantly fewer units of packed red blood cells were transfused in the TXA group (2 units v. 8 units); however, 2 of the units in the control group were given intraoperatively, and when these were excluded the difference was not significant. The incidence of ACS, CVA, VTE, SSI, transfusion and all-cause mortality at 90 days did not differ significantly between the groups.Conclusion: Topical TXA reduces early postoperative blood loss after hip fracture surgery without increased patient risk.Trial registration: Clinicaltrials.gov, no. NCT02993341.