Blood loss during the hip fracture surgeries is known to cause increased incidence of post- operative complications leading to higher morbidity and mortality. Tranexamic Acid (TxA) has previously been proved effective to reduce blood loss in trauma patients and elective orthopaedic surgeries. Further, we discovered a lack of hospital policies regarding the use of tranexamic acid in hip fracture surgeries. The NICE guidelines published on 4th June,2020 recommended the use of TxA in elective arthroplasty procedures to minimise blood loss, however guidelines to the use of TxA in Hip Fracture surgeries have not yet been established.
The study was conducted to assess TxA efficacy in reducing the need for blood transfusion when used pre operatively in Hip Fracture surgeries.
The study comprised of Hip Fracture surgeries at Milton Keynes University Hospital with a pre-operative administration of Tranexamic acid (TxA) at the dose of 10-15 mg/kg on anaesthetic induction. The data collected retrospectively included 191 patients from 25/9/2019 to 25/9/2020. Based on gender distribution of the 191 patients included, 133 included female patients and 58 male patients. The exclusion criteria for the study were based on TxA allergy, poly-trauma and pathological fractures. Meanwhile Inclusion criteria comprised of the remaining Hip fracture patients with a cut off Haemoglobin of 10g/dl or above preoperatively. The patients included ranged from 31 to 101 years of age with a mean age of 82.2.
Of the 191 patients 90 patients received TxA preoperatively compared to the other 101 patients not receiving TxA pre op. The findings concluded 94.4% of the patients receiving TxA pre-operatively did not require blood transfusion whereas of the patients not receiving TXA 36% required blood transfusion (p value < 0.001).
The study reflects a clear inclination towards a lesser need for blood transfusion in the patients receiving TxA pre-operatively. Additionally, the previous literature based on systematic reviews and meta- analysis reflects a reduced need for blood transfusion by 30% in all traumatic surgeries adding to reduced length of hospital stay and financial burdens.
Recommendation: To formulate a set of standard guidelines recommending the use of TxA in all hip fracture surgeries unless contraindicated.