The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis.

İsmail Burak Atalay,Emek Mert Duman,Aliekber Yapar,Recep Ozturk,Bedii Şafak Güngör,Coskun Ulucakoy,Güray Toğral

doi:10.7759/cureus.10105

Abstract

Aim: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion.Methods: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements.Results: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed.Conclusion: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event.Level of Evidence: Level III - retrospective comparative study.

Highlights

Resection or amputation are traditional methods of treatment of bone tumors, and wide radical excision forms the basis of surgery for malignant bone tumors
Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg Tranexamic acid (TXA) administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event
The aim of this study is to evaluate perioperative blood loss and transfusion needs of patients who underwent tumor resection prosthesis due to malignancy with proximal femur involvement in our clinic compared to the application of TXA

Summary

Introduction

Resection or amputation are traditional methods of treatment of bone tumors, and wide radical excision forms the basis of surgery for malignant bone tumors. In studies that did not use antifibrinolytic after major surgeries, significant perioperative blood loss ranging from 500 ml to 2000 ml was observed [1,2,3]. There is an increasing number of studies that develop methods to reduce perioperative blood loss associated with orthopedic tumor resection. Tranexamic acid (TXA) is a commonly used lysine analogue drug As it has an antifibrinolytic effect, it is increasingly used in practice to reduce blood loss. There are many studies reporting the decrease in postoperative blood loss in patients receiving TXA. It has been reported in the literature that TXA is used in malignancies [5,6,7,8]. In a study performed in patients with malignant bleeding, there was no evidence that the use of TXA increased the risk of thrombosis [8]

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