The role of intravenous tranexamic acid for blood loss in total hip arthroplasty secondary to femoral neck fracture

Abstract

Aim: The aim of the study was to compare the efficacy of intravenous (IV) administration of tranexamic acid (TXA) in terms of bleeding volume, allogeneic blood transfusion (ABT) requirement, and complications in total hip arthroplasty (THA) secondary to osteoporotic femoral neck fracture (FNF). Material and Method: A total of 165 patients who underwent THA on the background of FNF in our clinic were included in the study. Patients' demographic data, preoperative and postoperative blood parameters, the amount of blood loss calculated according to the Nadler formula, amount of ABT, and complications at the 90-day follow-up were recorded. The patients were divided into two groups those who received 15mg/kg preoperatively and 10mg/kg IV TXA at the end of the operation (TXA group-89 patients) and those who did not receive TXA (Control group-76 patients) and the two groups were compared. Results: The total amount of bleeding calculated according to the Nadler formula was significantly less in the TXA group (1659,68±320,86ml) compared with the Control group (1774,43±365,24ml) (p=0.033). The need for ABT was 42.86% in the TXA group and 57.14% in the control group, and this difference was statistically significant (p=0.008). Conclusion: In patients who underwent THA on the basis of osteoporotic FNF, preoperative and postoperative administration of 2 doses of IV TXA significantly reduced total blood loss and the need for ABT. We suggest that IV TXA administration can be safely performed, especially in this patient group, to reduce the amount of bleeding and therefore the need for ABT by not increasing any thromboembolic complications.

Keywords

• Total hip arthroplasty
• tranexamic acid
• blood loss
• allogeneic blood transfusion
• nadler

References

1. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the united states. JAMA 2009; 302: 1573-9.
2. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997; 7: 407-13.
3. Maceroli M, Nikkel LE, Mahmood B, et al. Total hip arthroplasty for femoral neck fractures: ımproved outcomes with higher hospital volumes. Journal of Orthopaedic Trauma 2016; 30: 597-604.
4. Kim JL, Park JH, Han SB, Cho IY, Jang KM. Allogeneic blood transfusion ıs a significant risk factor for surgical-site ınfection following total hip and knee arthroplasty: A meta-analysis. J Arthroplasty 2017; 32: 320-5.
5. Li J, Zhang Z, Chen J. Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty. Medicine (Baltimore) 2016; 95: e4689
6. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999; 57: 1005-32.
7. Li G, Sun TW, Luo G, Zhang C. Efficacy of antifibrinolytic agents on surgical bleeding and transfusion requirements in spine surgery: a meta-analysis. Eur Spine J 2017; 26: 140-54.
8. Moskal JT, Capps SG. Meta-analysis of ıntravenous tranexamic acid in primary total hip arthroplasty. Orthopedics 2016; 39: 883-92.

9. Machin JT, Batta V, Soler JA, Sivagaganam K, Kalairajah Y. Comparison of intra-operative regimes of tranexamic acid administration in primary total hip replacement. Acta Orthop Belg 2014; 80: 228-33.
10. Şahin İG, Akalin Y, Çevik N, Otuzbir A, Özkan Y, Öztürk A. Tranexamic acid in total knee replacement which protocol? which application form? A prospective randomised study. Acta Orthop Belg 2019; 85: 484-93.
11. Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. The Journal of Arthroplasty 2018; 33: 3083-9
12. Sun C, Zhang X, Chen L, et al. Comparison of oral versus intravenous tranexamic acid in total knee and hip arthroplasty: A grade analysis and meta-analysis. Medicine 2020; 99: 22999.
13. Watts CD, Houdek MT, Sems SA, Cross WW, Pagnano MW. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: A Randomized Clinical Trial. J Orthop Trauma 2017; 31: 345-51.
14. Maalouly J, Tawk A, Ayoubi R, et al. Efficacy of the combined administration of systemic and ıntra-articular tranexamic acid in total hip arthroplasty secondary to femoral neck fracture: a retrospective study. Advances in Orthopedics 2020; 2020: 1-6.
15. Yue R, Yang M, Deng X, Zhang P. Allogeneic red blood cell transfusion rate and risk factors after hemiarthroplasty in elderly patients with femoral neck fracture. Front Physiol 2021; 12: 701467.
16. Whitaker B, Rajbhandary S, Kleinman S, Harris A, Kamani N. Trends in united states blood collection and transfusion: results from the 2013 aabb blood collection, utilization, and patient blood management survey. Transfusion 2016; 56: 2173-83.
17. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery 1962; 51: 224-32.
18. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992; 2: 285-9.
19. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop 2011; 45: 15-22.
20. Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J. Intravenous versus topical tranexamic acid in primary total hip replacement: A meta-analysis Medicine 2016; 95 :e5573.
21. Lee YC, Park SJ, Kim JS, Cho CH. Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement. Journal of Clinical Anesthesia 2013; 25: 393-8.
22. Wang C, Kang P, Ma J, Yue C, Xie J, Pei F. Single-dose tranexamic acid for reducing bleeding and transfusions in total hip arthroplasty: A double-blind, randomized controlled trial of different doses. Thromb Res 2016; 141: 119-23.
23. Imai N, Dohmae Y, Suda K, Miyasaka D, Ito T, Endo N. Tranexamic acid for reduction of blood loss during total hip arthroplasty. J Arthroplasty 2012; 27: 1838-43.
24. Wind TC, Barfield WR, Moskal JT. The Effect of Tranexamic Acid on Transfusion Rate in Primary Total Hip Arthroplasty. The Journal of Arthroplasty 2014; 29: 387-9.
25. Andersson L, Nilsson IM, Niléhn JE, Hedner U, Granstrand B, Melander B. Experimental and clinical studies on AMCA, the antifibrinolytically active isomer of p-aminomethyl cyclohexane carboxylic acid. Scand J Haematol 1965; 2: 230-47.