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. 2023 Feb;49(1):209-216.
doi: 10.1007/s00068-022-02042-6. Epub 2022 Jul 19.

Does tranexamic acid reliably reduce blood loss in proximal femur fracture surgery?

A Fenwick #  1 , I Antonovska #  2 , M Pfann  2 , J Mayr  2 , A Wiedl  2 , S Nuber  2 , S Förch  2 , E Mayr  2
Affiliations

Does tranexamic acid reliably reduce blood loss in proximal femur fracture surgery?

A Fenwick et al. Eur J Trauma Emerg Surg. 2023 Feb.

Abstract

Purpose: The aim of our study was to investigate the use of tranexamic acid in patients with proximal femoral fractures and compare the total blood loss, transfusion rates, complications, and the application method.

Methods: A retrospective single center cohort study (level I trauma center) with 1479 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 was performed. 1 g of tranexamic acid was applied (systemic, topic or combined application). Patient data, surgical procedure, complications, and mortality were assessed. Hemoglobin levels, blood loss and transfusion rates for patients with and without tranexamic acid and the application methods were compared.

Results: 667 femoral neck fractures, 701 pertrochanteric and 109 subtrochanteric fractures were included. Mean age was 80.8 years. 274 patients received tranexamic acid. At admission average hemoglobin was 12.2 g/l. Hemoglobin drop postoperatively was less after tranexamic acid (9.72 vs. 9.35 g/dl). Transfusion rates were lowered significantly by 17.1% after tranexamic acid. Blood loss was reduced for all patients after tranexamic acid independent of fracture morphology. The combination of 1 g i.v. and 1 g topical-applied tranexamic acid seems to be more effective. Complication rates did not differ.

Conclusion: Tranexamic acid is effective in reducing blood loss and transfusion rates, without increasing the risk of thromboembolic events after proximal femoral fractures. For open reduction and nailing and arthroplasty in fracture setting combined topical and single i.v. application seems most effective and closed reduction with nailing can be treated by single dose i.v. application of 1 g tranexamic acid.

Keywords: Blood loss; Proximal femur fracture; Tranexamic acid; Transfusion rate.

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Conflict of interest statement

All authors read and approved of the final manuscript. All authors believe this study represents honest work. All authors, their immediate families, and any research foundation with which they are affiliated with did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. There has been no prior publication or submission. Annabel Fenwick, Iana Antonovska, Michael Pfann, Jakob Mayr, Andreas Wiedl, Stefan Förch, Stefan Number and Edgar Mayr declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart patient inclusion criteria and group distribution according to anticoagulants
Fig. 2
Fig. 2
Comparison of total blood loss after different application methods of tranexamic acid to patients without tranexamic acid
See this image and copyright information in PMC

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