# Tranexamic Acid Associated With Reduced Postoperative Transfusion Rates in Hip Fracture Surgery: A Retrospective Study

## TL;DR

This study finds that using tranexamic acid during hip fracture surgery reduces the need for blood transfusions without increasing dangerous blood clots.

## Contribution

The study provides new evidence that tranexamic acid reduces postoperative transfusion rates in hip fracture surgery without increasing thromboembolic risks.

## Key findings

- Tranexamic acid was associated with a 36% lower risk of postoperative transfusion.
- Day 1 postoperative hemoglobin levels were significantly higher in the tranexamic acid group.
- No significant increase in venous thromboembolism events was observed with tranexamic acid use.

## Abstract

Aims

In hip fracture surgery, blood transfusions are common. Allogenic blood transfusions can be associated with adverse effects, and so their use should be reduced where possible. The current study aims to further the knowledge base around the use of tranexamic acid (TXA) in hip fracture surgery patients. This study will focus on outcomes following the use of perioperative TXA in hip fracture patients, with the primary aim of assessing transfusion rates and thromboembolic events.

Methods

This was a single-centre, retrospective cohort study performed in a high-volume academic trauma unit managing 416 hip fractures per year. Patients undergoing surgery for a hip fracture between August 1, 2019, and August 1, 2020 were included. Two groups, based on whether or not the patient received TXA, were identified. Primary outcomes of interest were transfusion rates, postoperative haemoglobin levels, and the rate of venous thromboembolism (VTE).

Results

A total of 351 patients were included, 178 in the control group and 173 in the TXA group. On univariate analysis, there were four variables associated with postoperative transfusion: age (RR 1.03, 95% CI 1.01-1.04, p < 0.0001), American Society of Anaesthesiologists (ASA) (RR 1.75, 95% CI 1.35-2.27, p < 0.001), TXA (RR 0.64, 95% CI 0.45-0.94, p = 0.022), and preoperative haemoglobin level (RR 0.93, 95% CI 0.90-0.94, p < 0.0001). On multivariate analysis, both the preoperative haemoglobin (p < 0.0001) and administration of TXA (p = 0.047) were significantly associated with a reduced need for postoperative transfusions. Day 1 haemoglobin levels in the TXA group were significantly higher compared to the no-TXA group (107 g/L, s = 19.9, 95% CI 103.1-109.8 vs 101 g/L, s = 19.2, 95% CI 97.9-104.1, p = 0.0183). With regards to VTE, there was no statistically significant increase in the rate of VTE with the use of TXA for deep venous thrombosis (DVT) (p = 0.242) or pulmonary embolism (PE) (p = 0.242).

Conclusion

Administering intraoperative TXA is associated with reduced postoperative transfusion rates and improved postoperative haemoglobin levels in hip fracture patients, while not increasing VTE events. Further research in this field should focus on determining an ideal dose, mode of delivery, and timing of TXA administration to optimise its efficacy.