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Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures

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Abstract

Purpose

The purpose was to evaluate the impact of intra-operative administration of tranexamic acid (TXA) and pre-operative discontinuation of prophylactic chemoprophylaxis in patients undergoing internal fixation of pelvic or acetabular fractures on the need for subsequent blood transfusion. Operative time and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were also assessed.

Methods

Data from a single level one trauma centre was retrospectively reviewed from January 2014 to December 2017 to identify pelvic ring or acetabular fractures managed operatively. Patients who did not receive their scheduled dose of chemoprophylaxis prior to surgery but who did receive intra-operative TXA were identified as the treatment group. Due to the interaction of VTE prophylaxis and TXA, the variables were analyzed using an interaction effect to account for administration of both individually and concomitantly.

Results

One hundred fifty-nine patients were included. The treatment group experienced a 20.7% reduction in blood product transfusion (regression coefficient (RC): − 0.207, p = 0.047, 95%CI: − 0.412 to − 0.003) and an average of 36 minutes (RC): − 36.90, p = 0.045, 95%CI: − 72.943 to − 0.841) reduction in surgical time as compared to controls. The treatment group did not experience differential rates of PE or DVT (RC: 1.302, p = 0.749, 95%CI: 0.259–6.546) or PE (RC: 1.024, p = 0.983, 95%CI: 0.114–9.208).

Conclusions

In the study population, the combination of holding pre-operative chemoprophylaxis and administering intra-operative TXA is a safe and effective combination in reducing operative time and blood product transfusions.

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Authors and Affiliations

  1. Department of Orthopaedics, Jackson Memorial Hospital/University of Miami, PO Box 016960 (D27), Miami, FL, 33101, USA

    Wayne B. Cohen-Levy, Augustus J. Rush III, Roberto C. Hernandez-Irizarry & Stephen M. Quinnan

  2. University of Miami Miller School of Medicine, 1600 NW 10th Ave, #1140, Miami, FL, 33136, USA

    Joshua P. Goldstein

  3. Department of Surgery, University of Hawaii at Manoa, Queen’s University Tower, 1356 Lusitana St., Honolulu, HI, 98813, USA

    Jonathan I. Sheu

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  1. Wayne B. Cohen-Levy
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Correspondence to Wayne B. Cohen-Levy.

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Investigation Performed at Jackson Memorial Hospital, Miami, FL

The University of Miami Institutional Review Board approved this study. This research was previously presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Mar 12–16, 2019.

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Cohen-Levy, W.B., Rush, A.J., Goldstein, J.P. et al. Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures. International Orthopaedics (SICOT) 44, 1815–1822 (2020). https://doi.org/10.1007/s00264-020-04595-w

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