Résultats cliniques de l’acide tranexamique dans les hémiarthroplasties de la hanche, réalisées en urgence, chez les patients gériatriques fragiles - 23/08/22
Clinical outcomes of tranexamic acid in acute hip hemiarthroplasties in frail geriatric patients
, Gert R. Roukema a, Tjallingius M. Kuijper c, Louis de Jong bAbstract |
Background |
Tranexamic acid (TXA) has shown to significantly reduce perioperative blood loss in elective orthopedic joint replacement surgery but is yet not implemented in acute hip fracture surgery for elderly patients who are particularly vulnerable to perioperative blood loss and postoperative anemia. Aim of this study is to answer the following questions: 1. Does TXA reduce bleeding associated complications in elderly patients? 2. Does TXA induce thromboembolic complications in elderly patients?
Hypothesis |
TXA reduces perioperative blood loss and associated complications in acute hip fracture surgery in geriatric patients.
Patients and methods |
In this observational cohort study with prospectively enrolled patients over 65years of age who received an acute hip hemiarthroplasty, the primary outcome was blood loss, also described as Δ hemoglobin. Secondary outcomes were bleeding associated complications as hematomas. Also, the occurrence of thromboembolic events and mortality were examined.
Results |
In total 864 geriatric patients were included of which 235 received TXA and 629 did not. Multivariable analysis showed reduced Δ hemoglobin loss (–0.24 (–0.39; –0.09), p=0.002) and hematomas (OR 0.44 (0.21; 0.91), p=0.026). Pulmonary embolism were diagnosed more frequently after administration of TXA (2% versus 0.3%, p=0.008), without an association with increased 30-day mortality rate (6% versus 8%, p=0.3).
Discussion |
TXA reduced perioperative blood loss and associated complications. However, adverse effects of TXA as pulmonary embolisms were found more frequently without effecting postoperative mortality rates. More research is needed to assess adverse effects of intravenous TXA and topical TXA as an alternative for systemic TXA to prevent systemic adverse effects.
Level of evidence |
III, Observational cohort study.
Le texte complet de cet article est disponible en PDF.Keywords : Geriatric patients, Hip hemiarthroplasty (HA), Tranexamic acid, Clinical outcomes
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 108 - N° 5
P. 572 - septembre 2022 Retour au numéro
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