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Influence of single-dose intravenous tranexamic acid on total hip replacement

A study on transfusions, collateral complications, and readmissions

Einfluss einer intravenösen Einzelgabe von Tranexamsäure auf die Implantation einer Hüfttotalendoprothese

Eine Studie zu Transfusionen, kolateralen Komplikationen und Rehospitalisierungen

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Abstract

Introduction

To determine the effects of tranexamic acid (TXA) on transfusions in patients undergoing hip replacement with a hybrid or cementless prosthesis.

Methods

A group of 172 consecutive patients aged 18 years or older who underwent elective hip replacement with uncemented or hybrid prostheses, undergoing surgery between January 2012 and January 2014 by the same primary surgeon and anesthesiologist, were retrospectively included. TXA (1 g) was administered immediately before incision in the TXA group. Primary variables included number of red blood cell transfusions and the influence of TXA for each type of prosthesis. Secondary variables included hematocrit at discharge, length of hospital stay, thrombosis or pulmonary embolism, seizures, and death.

Results

Average transfusion was 1.53 units/patient in the control group compared to 0.6 units/patient in the TXA group (z = 6.29; U = 1640.5; p < 0.0001). TXA use was significantly correlated with the number of units transfused (p < 0.0001, 95% CI −1.24 to −0.68). Odds risk reduction for transfusion was observed during surgery (OR: 0.14; CI 0.06–0.29; p < 0.0001) and during the rest of hospital stay (OR: 0.11; CI 0.01–0.96; p = 0.046). Both hybrid and cementless prostheses that received TXA were transfused less than control groups (0.57 ± 1 vs. 1.7 ± 1 p < 0.01 and 0.65 ± 1 vs. 1.24 ± 1 p < 0.01). No difference was observed between the groups regarding adverse effects. Hematocrit values at discharge and length of hospital stay were similar between groups. No deaths were observed during hospital stay.

Conclusions

TXA reduced transfusions without increasing the prevalence of adverse effects. This reduction was observed during surgery and the following days of hospital stay for both for hybrid and cementless prosthesis.

Zusammenfassung

Einleitung

Die Auswirkungen von Tranexamsäure (TXA) auf die Transfusionen bei Patienten, die sich einer Operation zur Implantation einer Hybrid- oder zementfreien Endoprothese unterzogen, werden bestimmt.

Methoden

Eine Gruppe von 172 konsekutiven Patienten ≥18 Jahren, die zwischen Januar 2012 und Januar 2014 im Rahmen einer Hüftoperation, die vom selben Chirurgen und Anästhesisten durchgeführt wurde, eine zementfreie oder Hybridendoprothese erhielten, wurden retrospektiv eingeschlossen. Die TXA (1 g) wurde in der TXA-Gruppe unmittelbar vor der Inzision injiziert. Die primären Variablen waren die Anzahl der übertragenen roten Blutkörperchen sowie der Einfluss von TXA auf jede Endoprothesenform. Die sekundären Variablen waren Hämatokrit bei Entlassung aus dem Krankenhaus, Hospitalisationsdauer, Thrombose oder Lungenembolie, Epilepsie und Tod.

Ergebnisse

Die durchschnittliche Transfusionsmenge betrug 1,53 Einheiten/Patient in der Kontrollgruppe verglichen mit 0,6 Einheiten/Patient in der TXA-Gruppe (z = 6,29; U = 1640,5; p < 0,0001). TXA korrelierte signifikant mit der Anzahl der übertragenen Einheiten (p < 0,0001; 95% CI −1,24 und −0,68). Während der Operation wurde eine Reduzierung des Odds-Ratios beobachtet (OR: 0,14; 95% CI 0,06–0,29; p < 0,0001) sowie auch während der übrigen Hospitalisationsdauer (OR: 0,11; 95% CI 0,01–0,96; p = 0,046). Sowohl in der Gruppe mit Hybridendoprothese als auch in der Gruppe mit zementfreier Endoprothese, die beide TXA erhalten hatten, waren weniger Transfusionen nötig als bei den Kontrollgruppen (0,57 ± 1 vs. 1,7 ± 1; p < 0,01 und 0,65 ± 1 vs. 1,24 ± 1; p < 0,01). Hinsichtlich der unerwünschten Ereignisse wurde kein Unterschied zwischen den Gruppen festgestellt. Die Hämatokritwerte bei Entlassung und die Hospitalisationsdauer waren in beiden Gruppen ähnlich. Todesfälle während des Krankenhausaufenthalts gab es keine.

Schlussfolgerung

TXA reduzierte die Transfusionen, ohne das Auftreten unerwünschter Ereignisse zu erhöhen. Diese Reduzierung wurde während der Operation und in den folgenden Tagen des Krankhausaufenthalts sowohl in der Gruppe mit Hybridendoprothese als auch in der Gruppe mit zementfreier Endoprothese beobachtet.

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Author information

Authors and Affiliations

  1. Anesthesiology Department, Italian Hospital of Buenos Aires, Peron 4190, C1181ACH, Buenos Aires, Argentina

    A. Fígar & S. Mc Loughlin

  2. Institute of Orthopedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina

    P. A. Slullitel & M. A. Buttaro

  3. Transfusion Medicine and Hemotherapy Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina

    W. Scordo

Authors
  1. A. Fígar
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  2. S. Mc Loughlin
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  3. P. A. Slullitel
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  4. W. Scordo
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  5. M. A. Buttaro
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Corresponding author

Correspondence to S. Mc Loughlin.

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Conflict of interest

A. Fígar, S. Mc Loughlin, P.A. Slullitel, W. Scordo, and M.A. Buttaro declare that they have no competing interests.

The present study was approved by the Ethics Board of our institution “Comité de Etica de Protocolos de Investigación (CEPI)”; “Hospital Italiano de Buenos Aires”. The present study was waived from informed consent by the Ethics Review Board due to its retrospective design. All details that might disclose the identity of the subjects under study have been omitted.

Additional information

Authors contribution: Fígar A, Mc Loughlin S, and Slullitel PA designed the research, analyzed the data, and wrote the manuscript; Scordo W provided data from the blood bank and transfusions; Buttaro MA performed the surgeries and overviewed analysis and final manuscript.

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Fígar, A., Mc Loughlin, S., Slullitel, P.A. et al. Influence of single-dose intravenous tranexamic acid on total hip replacement. Orthopäde 46, 359–365 (2017). https://doi.org/10.1007/s00132-016-3352-8

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