The safety and efficacy of sequential use of tranexamic acid in perioperative period of half hip replacement for femoral neck fracture in the elderly_West China Medical Journal

Authors：

WANG Meifu ¹ , ZHOU Dechun ¹ , WANG Yaquan ¹ , WANG Haoyang ² ,  ZHOU Zongke ²

1. Department of Orthopedics, Meishan Traditional Chinese Medicine Hospital, Meishan, Sichuan 620010, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOU Zongke, Email: zongke@126.com

Keywords：

Femoral neck fracture; Tranexamic acid; Half hip replacement

DOI：

10.7507/1002-0179.201908121

Video：

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Objective To investigate the safety and efficacy of sequential use of tranexamic acid (TXA) in the perioperative period of half hip replacement for femoral neck fracture in the elderly.Methods Patients who underwent hemiarthroplasty due to femoral neck fracture in Meishan Traditional Chinese Medicine Hospital from January 2016 to October 2018 were retrospectively included. According to the use of TXA during the perioperative period, the patients were divided into group A (no use of TXA), group B (TXA use on the day of surgery), and group C (sequential therapy). The perioperative blood loss, blood transfusion rate and incidence of deep vein thrombosis (DVT) in the 3 groups were recorded and counted.Results A total of 113 patients were included, and 99 patients were finally included (31 in group A, 36 in group B, and 32 in group C). There were no statistically significant difference in age, sex, body mass index, hemoglobin (Hb) at admission, hematocrit at admission, blood volume, or blood transfusion among the three groups. The differences in total blood loss (F=43.613, P<0.001), preoperative blood loss (F=4.746, P=0.011), preoperative Hb (F=6.220, P=0.003), maximum Hb change (F=18.913, P<0.001), and postoperative length of hospital stay (F=43.511, P<0.001) among the three groups were statistically significant. There was no DVT of the lower extremities or pulmonary embolism found in the three groups. The differences in preoperative blood loss and preoperative Hb were not statistically significant between group A and group B. The difference in postoperative length of hospital stay was not statistically significant between group B and group C. The differences in other indexes between all the pairs of the three groups were statistically significant (P<0.05).Conclusion Using TXA early after femoral neck fracture and sequentially to the day of surgery can reduce perioperative blood loss, including hidden blood loss before surgery and blood loss during and after the operation, which is beneficial to patients’ postoperative recovery without increasing the risk of DVT.

Citation： WANG Meifu, ZHOU Dechun, WANG Yaquan, WANG Haoyang, ZHOU Zongke. The safety and efficacy of sequential use of tranexamic acid in perioperative period of half hip replacement for femoral neck fracture in the elderly. West China Medical Journal, 2020, 35(1): 41-45. doi: 10.7507/1002-0179.201908121 Copy

1.	Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures. Bone, 1996, 18(Suppl 1): 57S-63S.
2.	Raaymakers EL. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech, 2006, 73(1): 45-59.
3.	Gardner MJ, Brophy RH, Demetrakopoulos D, et al. Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am, 2005, 87(1): 3-7.
4.	Lee C, Freeman R, Edmondson M, et al. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury, 2015, 46(10): 1978-1982.
5.	Luo ZY, Wang D, Meng WK, et al. Oral tranexamic acid is equivalent to topical tranexamic acid without drainage in primary total hip arthroplasty: a double-blind randomized clinical trial. Thromb Res, 2018, 167: 1-5.
6.	Wang D, Zhu H, Meng WK, et al. Comparison of oral versus intra-articular tranexamic acid in enhanced-recovery primary total knee arthroplasty without tourniquet application: a randomized controlled trial. BMC Musculoskelet Disord, 2018, 19(1): 85.
7.	岳辰, 周宗科, 裴福兴, 等. 中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识. 中华骨与关节外科杂志, 2015, 8(4): 281-285.
8.	陈孝平. 外科学(上册). 北京: 人民卫生出版社, 2005: 77.
9.	王浩洋, 康鹏德, 裴福兴, 等. 氨甲环酸减少全髋关节置换术围手术期失血的有效性及安全性研究. 中国骨与关节杂志, 2015, 4(8): 649-654.
10.	Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br, 2004, 86(4): 561-565.
11.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
12.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
13.	Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br, 2006, 88(8): 1053-1059.
14.	Gausden EB, Garner MR, Warner SJ, et al. Tranexamic acid in hip fracture patients: a protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients. BMJ Open, 2016, 6(6): e010676.
15.	Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res, 2014, 8(1): 48-53.
16.	Ramirez RJ, Spinella PC, Bochicchio GV. Tranexamic acid update in trauma. Crit Care Clin, 2017, 33(1): 85-99.
17.	Xie J, Hu Q, Huang Q, et al. Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty: an updated meta-analysis. Thromb Res, 2017, 153: 28-36.
18.	Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
19.	Perreault RE, Fournier CA, Mattingly DA, et al. Oral tranexamic acid reduces transfusions in total knee arthroplasty. J Arthroplasty, 2017, 32(10): 2990-2994.
20.	Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
21.	Zhang P, He J, Fang Y, et al. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine (Baltimore), 2017, 96(21): e6940.
22.	CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011, 377(9771): 1096-1101, 1101.e1-2.
23.	Molt M, Harsten A, Toksvig-Larsen S. The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee, 2014, 21(2): 396-401.
24.	Kärrholm J, Borssén B, Löwenhielm G, et al. Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br, 1994, 76(6): 912-917.

1. Kannus P, Parkkari J, Sievänen H, et al. Epidemiology of hip fractures. Bone, 1996, 18(Suppl 1): 57S-63S.
2. Raaymakers EL. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech, 2006, 73(1): 45-59.
3. Gardner MJ, Brophy RH, Demetrakopoulos D, et al. Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am, 2005, 87(1): 3-7.
4. Lee C, Freeman R, Edmondson M, et al. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury, 2015, 46(10): 1978-1982.
5. Luo ZY, Wang D, Meng WK, et al. Oral tranexamic acid is equivalent to topical tranexamic acid without drainage in primary total hip arthroplasty: a double-blind randomized clinical trial. Thromb Res, 2018, 167: 1-5.
6. Wang D, Zhu H, Meng WK, et al. Comparison of oral versus intra-articular tranexamic acid in enhanced-recovery primary total knee arthroplasty without tourniquet application: a randomized controlled trial. BMC Musculoskelet Disord, 2018, 19(1): 85.
7. 岳辰, 周宗科, 裴福兴, 等. 中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识. 中华骨与关节外科杂志, 2015, 8(4): 281-285.
8. 陈孝平. 外科学(上册). 北京: 人民卫生出版社, 2005: 77.
9. 王浩洋, 康鹏德, 裴福兴, 等. 氨甲环酸减少全髋关节置换术围手术期失血的有效性及安全性研究. 中国骨与关节杂志, 2015, 4(8): 649-654.
10. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br, 2004, 86(4): 561-565.
11. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
12. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
13. Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br, 2006, 88(8): 1053-1059.
14. Gausden EB, Garner MR, Warner SJ, et al. Tranexamic acid in hip fracture patients: a protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients. BMJ Open, 2016, 6(6): e010676.
15. Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res, 2014, 8(1): 48-53.
16. Ramirez RJ, Spinella PC, Bochicchio GV. Tranexamic acid update in trauma. Crit Care Clin, 2017, 33(1): 85-99.
17. Xie J, Hu Q, Huang Q, et al. Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty: an updated meta-analysis. Thromb Res, 2017, 153: 28-36.
18. Kim KT, Kim CK, Kim YC, et al. The effectiveness of low-dose and high-dose tranexamic acid in posterior lumbar interbody fusion: a double-blinded, placebo-controlled randomized study. Eur Spine J, 2017, 26(11): 2851-2857.
19. Perreault RE, Fournier CA, Mattingly DA, et al. Oral tranexamic acid reduces transfusions in total knee arthroplasty. J Arthroplasty, 2017, 32(10): 2990-2994.
20. Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
21. Zhang P, He J, Fang Y, et al. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine (Baltimore), 2017, 96(21): e6940.
22. CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011, 377(9771): 1096-1101, 1101.e1-2.
23. Molt M, Harsten A, Toksvig-Larsen S. The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee, 2014, 21(2): 396-401.
24. Kärrholm J, Borssén B, Löwenhielm G, et al. Does early micromotion of femoral stem prostheses matter? 4-7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br, 1994, 76(6): 912-917.

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The safety and efficacy of sequential use of tranexamic acid in perioperative period of half hip replacement for femoral neck fracture in the elderly

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