Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures

OBJECTIVES: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients. DESIGN: Retrospective cohort study. SETTING: Academic Tertiary Care Center. PATIENTS/PARTICIPANTS: Series of 209 patients with fr...

Descripción completa

Detalles Bibliográficos
Autores principales: Kahan, Joseph B., Morris, Jensa, Li, Don, Moran, Jay, O’Connor, Mary I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575430/
https://www.ncbi.nlm.nih.gov/pubmed/34765898
http://dx.doi.org/10.1097/OI9.0000000000000147
_version_ 1784595676774006784
author Kahan, Joseph B.
Morris, Jensa
Li, Don
Moran, Jay
O’Connor, Mary I.
author_facet Kahan, Joseph B.
Morris, Jensa
Li, Don
Moran, Jay
O’Connor, Mary I.
author_sort Kahan, Joseph B.
collection PubMed
description OBJECTIVES: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients. DESIGN: Retrospective cohort study. SETTING: Academic Tertiary Care Center. PATIENTS/PARTICIPANTS: Series of 209 patients with fragility hip fractures treated operatively from April 1, 2019 to September 30, 2019. INTERVENTION: Eligible patients received 4 intravenous doses of TXA. Some patients missed doses and only received between 1 and 3 doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture > 48 hours prior to presentation. MAIN OUTCOME MEASURES: Red blood cell transfusion; major adverse vascular events; minor drug related adverse events. RESULTS: Patients who received all 4 doses of TXA (n = 70) had a significantly lower transfusion rate compared to those who did not receive any TXA (7.1% vs 28.1%, P = .003). There were no significant differences in the number of major or minor adverse events between the 2 groups. CONCLUSIONS: The use of a standardized TXA protocol of 4 doses significantly decreases transfusion rates in eligible patients undergoing operative intervention for fragility hip fracture without an increase in major or minor adverse events. These findings are even more pronounced in patients with decreased preoperative hemoglobin. Level of Evidence: Prognostic Level III
format Online
Article
Text
id pubmed-8575430
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-85754302021-11-10 Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures Kahan, Joseph B. Morris, Jensa Li, Don Moran, Jay O’Connor, Mary I. OTA Int Clinical/Basic Science Research Article OBJECTIVES: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients. DESIGN: Retrospective cohort study. SETTING: Academic Tertiary Care Center. PATIENTS/PARTICIPANTS: Series of 209 patients with fragility hip fractures treated operatively from April 1, 2019 to September 30, 2019. INTERVENTION: Eligible patients received 4 intravenous doses of TXA. Some patients missed doses and only received between 1 and 3 doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture > 48 hours prior to presentation. MAIN OUTCOME MEASURES: Red blood cell transfusion; major adverse vascular events; minor drug related adverse events. RESULTS: Patients who received all 4 doses of TXA (n = 70) had a significantly lower transfusion rate compared to those who did not receive any TXA (7.1% vs 28.1%, P = .003). There were no significant differences in the number of major or minor adverse events between the 2 groups. CONCLUSIONS: The use of a standardized TXA protocol of 4 doses significantly decreases transfusion rates in eligible patients undergoing operative intervention for fragility hip fracture without an increase in major or minor adverse events. These findings are even more pronounced in patients with decreased preoperative hemoglobin. Level of Evidence: Prognostic Level III Lippincott Williams & Wilkins 2021-09-15 /pmc/articles/PMC8575430/ /pubmed/34765898 http://dx.doi.org/10.1097/OI9.0000000000000147 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Clinical/Basic Science Research Article
Kahan, Joseph B.
Morris, Jensa
Li, Don
Moran, Jay
O’Connor, Mary I.
Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title_full Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title_fullStr Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title_full_unstemmed Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title_short Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
title_sort expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures
topic Clinical/Basic Science Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575430/
https://www.ncbi.nlm.nih.gov/pubmed/34765898
http://dx.doi.org/10.1097/OI9.0000000000000147
work_keys_str_mv AT kahanjosephb expandeduseoftranexamicacidissafeanddecreasestransfusionratesinpatientswithgeriatrichipfractures
AT morrisjensa expandeduseoftranexamicacidissafeanddecreasestransfusionratesinpatientswithgeriatrichipfractures
AT lidon expandeduseoftranexamicacidissafeanddecreasestransfusionratesinpatientswithgeriatrichipfractures
AT moranjay expandeduseoftranexamicacidissafeanddecreasestransfusionratesinpatientswithgeriatrichipfractures
AT oconnormaryi expandeduseoftranexamicacidissafeanddecreasestransfusionratesinpatientswithgeriatrichipfractures