Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures

Abstract

Purpose: To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA).

Methods: 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event.

Results: The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, p<0.001), during 0 to 24 hours (61.67 vs. 186.67 ml, p<0.001), and during 24 to 48 hours (27 vs. 86.67 ml, p<0.001), as well as the total volume (408.97 vs. 676.67 ml, p<0.001). Respectively for the TXA and control groups, 27 and 30 required 28 and 41 units of blood intra-operatively (p<0.001), and 6 and 15 required 6 and 15 units of blood postoperatively (p=0.014). No patient had any thromboembolic adverse event.

Conclusion: TXA is safe and effective in reducing blood loss in dynamic hip screw plate fixation for stable trochanteric fractures.

Keywords: blood loss, surgical; blood transfusion; hip fractures; postoperative hemorrhage; tranexamic acid.