This article is more than 5 years old. Information may no longer be current.
Subfascial administration of TXA lessened need for blood transfusions in older patients
Administration of TXA also lowered hemoglobin level and hematocrit in patients.
Click Here to Manage Email Alerts
Subfascial administration of tranexamic acid significantly reduced the need for blood transfusions in older patients undergoing intramedullary nailing for intertrochanteric fractures, according to study results.
“Subfascial administration of [tranexamic acid] TXA at the fracture site in elderly patients undergoing intramedullary nailing for intertrochanteric fractures decreases postoperative hematocrit and hemoglobin level decline,” Sokratis Varitimidis, MD, of the University of Thessaly, Medical School Biopolis, told Orthopedics Today. “A significant reduction in blood loss and transfused blood units can be achieved.”
Use of TXA
Varitimidis and his colleagues randomly assigned 200 patients older than 65 years of age who sustained intertrochanteric fractures. Patients underwent closed-fracture reduction and fixation with a Gamma3 locking nail (Stryker) and were randomized to receive subfascial administration of TXA around the fracture site at the end of the surgical procedure or no administration of TXA. Main outcome measures included group differences in number of transfused packed red blood cell units, as well as hematocrit, hemoglobin and platelet count.
“We hypothesized that local injection of TXA would reduce the needs of blood transfusions, while skipping the possible complications of intravenous administration,” Athanasios Drakos, MD, of the University of, Medical School Biopolis, told Orthopedics Today.
Results showed a lower mean drop in hemoglobin and hematocrit among patients in the TXA group on the first postoperative day, while the control group had a lower mean drop in the platelet count. However, these differences were no longer statistically significant by the third postoperative day. Patients in the TXA group required a lower number of blood transfusions (22%) compared with the control group (29%), with a total number of 27 and 48 transfused blood units, respectively. Both groups had a decrease in the number of packed red blood cell units transfused, with patients in the TXA group undergoing 18 packed red blood cell unit transfusions and the control group undergoing 30 transfusions on postoperative day 1 compared with nine and 18 packed red blood cell units transfused at the third postoperative day, respectively.
Researchers found no differences in terms of late complications and overall mortality rate between the two groups.
Patient comparison
Although this study presented the largest number of patients undergoing trochanteric fracture surgery, Varitimidis and Drakos noted future research should include another group receiving intravenous TXA administration for comparison.
“We have developed a new study enrolling a third group including patients who receive intravenous administration of TXA, but still is a work in progress,” Varitimidis said. – by Casey Tingle
- Reference:
- Drakos A, et al. J Orthop Trauma. 2016;doi:10.1097/BOT.0000000000000577.
- For more information:
- Athanasios Drakos, MD, can be reached at the department of orthopaedic surgery, University of Thessaly, Medical School Biopolis, Larissa 41110, Greece; email: drakosth@hotmail.com.
- Sokratis E. Varitimidis, MD, can be reached at the department of orthopaedic surgery, University of Thessaly, Medical School Biopolis, Larissa 41110, Greece; email: svaritimidis@ortho-uth.org.
Disclosure: Varitimidis reports no relevant financial disclosures.