Efficacy and Safety of Locally Injected Tranexamic Acid in Hip Fracture Patients: A retrospective Review.

Abstract

OBJECTIVE\nDetermine if locally injected tranexamic acid (TXA) used in the surgical treatment of fragility hip fractures can lower transfusion rates without increasing the risk of complications.\n\n\nDESIGN\nRetrospective comparative cohort.\n\n\nSETTING\nTertiary referral orthopedic specialty hospital, Level I trauma center.\n\n\nPATIENTS/PARTICIPANTS\nA total of 490 patients (252 patients received TXA) 50 years of age and over who underwent surgery for a low energy fragility fracture of the proximal femur between March 2018 and February 2020 were included in this study.\n\n\nINTERVENTION\nUse of locally injected TXA at the time of wound closure.\n\n\nMAIN OUTCOME\nThe main outcomes for this study were number of patients requiring post-operative blood transfusions, as well as incidences of venous thromboembolism (VTE) and surgical site infections.\n\n\nRESULTS\nA statistically significant difference was noted in the frequency of transfusion between patients who received TXA compared to those that did not receive TXA (33% vs. 43%, respectively) (p=0.034). There were no significant differences in VTE incidence (0.4% vs. 0.8% TXA vs. No TXA) (p=0.526), or infections (0.4% vs. 0.4% TXA vs. No TXA) (p=0.965). Regression analysis indicated the use of TXA reduced the need for postoperative blood transfusion by 31% (Odds Ratio: 0.688, 95%CI: 0.477-0.993, p=0.045).\n\n\nCONCLUSION\nLocally injected TXA significantly reduced the need for postoperative transfusion in the surgical treatment of fragility hip fractures. Additionally, there was no increased risk of complications in those receiving TXA versus those who do not. Locally injected TXA seems to be both a safe and effective way to reduce post-operative blood transfusions in patients with fragility hip fractures.