Estimation of efficacy on tranexamic acid in reducing peri-operative blood loss in patient undergoing hemiarthroplasty

Abstract

Introduction: Hip fracture surgeries are associated with substantial blood loss, exposing patients to postoperative anemia. The severity of anemia is related to reduced functional recovery, which is related to long-term mortality. Patients undergoing hemiarthroplasty surgeries require 1 to 2 pints of blood transfusion post operatively. There are many transfusion related health hazards. Tranexamic acid is a less expensive pharmacological agent that interferes with fibrinolysis and reduces blood loss in hemiarthroplasty surgeries. The aim of this study is to evaluate the efficacy of intra-venous administration of tranexamic acid in patients who underwent hemiarthroplasty with regards to blood loss at peri and post-operative period. Materials and Methods: Patients with fracture neck of femur, above 60 years who primarily presented to Emergency medical service medicine in our institution fulfilling the inclusion criteria were included in our study. After obtaining the informed consent, patients were grouped into two categories; group 1 and group 2. Group 1 intervention: Placebo- 50 ml of normal saline intravenously was administered 10 minutes before starting the surgery. Group 2 intervention: Study-Tranexamic acid -1500mg diluted in 50ml normal saline intravenously was administered 10 minutes before the surgery. Intra-operative blood loss was assessed by collecting the number of fully soaked mopping pads, gauze pieces and the quantity of irrigation fluid after substracting the amount of saline wash. Post operatively the efficacy was assessed by evaluating the hemoglobin and packed cell volume values. The blood collected in the drain on day 1 and 2 were also analysed and compared between the control group and the study group. Result: In our study we included 40 patients who had undergone hemiarthroplasty for neck of femur fracture. Intra operatively we did PRBC transfusion for 11 patients in the control group and 3 patients in the study group. Postoperatively 2 patients received PRBC transfusion in the control group and none of the patients received PRBC transfusion in the study group. The post surgery blood loss was also very minimal in the control group as compared to the study group. Conclusion: In our study, there was a significant amount of blood loss reduction in tranexamic acid administered group when compared to the placebo group. Tranexamic acid was cost effective and safer when compared to blood components. Tranexamic acid was useful and effective in reducing intra-operative blood loss and reduces the need for blood transfusion post-operatively. Tranexamic acid should be considered for routine use in hemiarthroplasty surgery to decrease blood loss.