Is Tranexamic Acid Safe and Efficacious in Hip Surgeries?

Abstract

BackgroundThe incidence of hip fractures is increasing in the current population. It is estimated by the year 2050 around 6.3 million hip fractures may occur per year. Management of hip fractures and replacement surgeries might be associated with substantial blood loss which leads to perioperative anemia. Tranexamic acid is an antifibrinolytic agent that has evidence of reducing blood loss during arthroplasty surgeries. This study aims to evaluate the efficacy and safety of tranexamic acid in patients undergoing hip surgeries.Materials and methodsThis is a cross-sectional study of the patients during the period of May 2020 to April 2021. Forty-eight patients who underwent hip surgery during this period were taken up for the study. Patients were divided into the following groups: group T (n=24) and group P (n=24). Group T received tranexamic acid 10 mg/kg intravenously, as a bolus slowly, 30 minutes prior to skin incision and 1 mg/kg/h intravenous infusion till the closure of skin incision. Group P received normal saline 0.1 ml/kg intravenously, as a bolus slowly, 30 minutes prior to skin incision, and then 1 ml/kg/h intravenous infusion till the skin closure. The primary outcome measured was the total blood loss using Gross and Nadel formulaand the secondary outcomes measured were packed red blood cell (PRBC) transfusion requirement, length of hospital stay, drop-in hematocrit value, ambulation time, and incidence of any other adverse event between the two groups.ResultsThe total blood loss in group T patients was 474.12 (± 90.35) ml and in group P was 647.41 (± 114.58) ml, the p-value was <0.001 which was statistically significant. The overall PRBC transfusion rate was 75% (18 patients) in group P and 37.5% (nine patients) in group T with a p-value of 0.020. Nine (37.5%) patients included in group T began to ambulate within 24 hours of surgery while six patients in group P were ambulated within 24 hours with a p-value of <0.001.ConclusionPreoperative infusion of tranexamic acid is effective in reducing intraoperative blood loss and blood transfusion requirement rates. It is also safe and efficacious in patients undergoing hip surgeries.