Does Tranexamic Acid Reduce the Need for Blood Transfusions in Patients Undergoing Hip Fracture Surgery?

Antifibrinolytic medications such as tranexamic acid, aprotinin, and aminocaproic acid have
proven to be useful in decreasing blood loss and the proportion of patients who require
transfusion after a number of surgical procedures. In orthopedic surgery, tranexamic acid
(TXA) is the best studied of these medications and a recent Cochrane Database review
determined that tranexamic acid was effective in decreasing perioperative bleeding and
post-operative transfusion after elective hip replacement and knee replacement surgery. At
Mayo Clinic Rochester, the routine administration of tranexamic acid has evolved over the
past decade to become part of the typical protocol for more than 3,000 elective hip and knee
replacement procedures each year. Recent administrative data provides fairly compelling
evidence of the efficacy of tranexamic acid in decreasing transfusion at the Mayo Clinic
Rochester practice with 2010 data showing 2% and 7% prevalence of transfusion in patients
treated with tranexamic acid versus 18% and 33% prevalence in those knee and hip replacement
patients, respectively, who were not treated with tranexamic acid. A recent analysis of the
Mayo Clinic Rochester orthopedic practice showed that patients treated for hip fracture
remain at substantial risk of perioperative transfusion (30% prevalence) after operative
management. This raises the question as to whether tranexamic acid could improve the
perioperative care of those patients treated surgically for hip fracture by decreasing the
proportion of patients requiring transfusion and decreasing total perioperative bleeding.

Inclusion criteria

- AO/OTA (Orthopedic Trauma Association) fracture classification 31B

- Surgically treated with either hemiarthroplasty or total hip arthroplasty

- Acute fracture treated within 72 hours of injury

- Low energy isolated injury

- Age greater than 18 years old

Exclusion Criteria

- Transfusion received during admission, prior to surgery

- Creatinine clearance less than 30 mL/min

- History of unprovoked Venous Thromboembolism (VTE) and/or recurrent VTE

- Known history of Factor V Leiden, protein C/S deficiency, prothrombin gene mutation,
anti-thrombin deficiency, anti-phospholipid antibody syndrome, lupus anticoagulant

- Pregnancy or breastfeeding (pregnancy tests will be performed on all patients of
child-bearing potential)

- History of cerebrovascular accident (CVA), Myocardial infarction (MI), or VTE within
the previous 30 days

- Coronary stent placement within the previous 6 months

- Disseminated intravascular coagulation

- Subarachnoid hemorrhage