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TXA in periacetabular osteotomy cases linked with decreased need for transfusions
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Results from this retrospective review showed the use of intravenous tranexamic acid during periacetabular osteotomy was linked to a decrease in transfusion requirements and not associated with an increased risk of thromboembolic disease.
“Similar to the research that has been done in the total joint population, tranexamic acid is effective at reducing blood loss and decreasing the allogenic transfusion requirement after joint preservation surgery, specifically the periacetabular osteotomy,” Andrew J. Bryan, MD, of the Department of Orthopedic Surgery at Mayo Clinic, told Orthopedics Today.
Use of TXA
Bryan and his colleagues identified 137 patients (150 hips) who underwent Bernese periacetabular osteotomy, of which 68 patients (75 hips) were treated with intravenous tranexamic acid (TXA) at both the time of the incision and wound closure and 69 patients (75 hips) who did not receive antifibrinolytic medication. Investigators compared the need for allogeneic and autologous transfusions between the groups and recorded postoperative hemoglobin levels, operative times and rates of thromboembolic disease occurring within 6 weeks of surgery.
Compared with the control group, results showed the TXA group had a lower mean number of total units transfused. The TXA group also had no allogeneic transfusions compared with 21% of patients in the control group. Investigators noted no differences between the groups with regard to autologous cell salvage requirements as well as risk of venous thromboembolic disease or arterial thromboembolic disease events.
“It was interesting [that] blood loss during these surgeries was fairly unpredictable,” Bryan said. “Even after surgeons became competent at the surgery, they still experienced blood loss in certain cases and it was hard to predict which patients would have more bleeding than others. The other surprising thing was just the drastic decrease in the allogeneic transfusion rate in patients who received the drug.”
Dosage, timing
According to Bryan, future research should focus on the best route of giving TXA to patients as well as whether to give patients multiple doses and at what the optimized timing would be to give patients TXA.
“We are going to test whether or not it is most beneficial and cost effective to give patients intravenous TXA or oral TXA and try to figure out dosing and timing of when to give the dose or multiple doses,” Bryan said. “Knowing if we could administer this after surgery in an oral form might be helpful.” – by Monica Jaramillo and Casey Tingle
- Reference:
- Bryan AJ, et al. Orthopedics. 2016;doi:10.3928/01477447-20151222-10.
- For more information:
- Andrew J. Bryan, MD, can be reached at the Mayo Clinic, 200 First St. SW, Rochester, MN 55905; email: bryan.andrew@mayo.edu.
Disclosure: Bryan reports no relevant financial disclosures.