Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery

Hip fractures are a common and serious injury, particularly among the elderly, often requiring surgery. Anaemia and the subsequent need for blood transfusion can complicate recovery and increase the risk of poor outcomes. A recent double-blind, randomized trial published in The Lancet Haematology conducted in France by Prof. Sigismond Lasocki and colleagues have shed light on a promising approach to reducing blood transfusion rates in patients undergoing hip fracture surgery.

A randomized double-blind factorial trial involving 413 patients aged 51 to 104 years, with a median age of 86 (IQR 78-91) and 76% women, assessed the impact of intravenous iron and tranexamic acid on blood transfusion rates following hip fracture surgery. Conducted from March 31, 2017, to June 18, 2021, the study allocated participants to four groups: iron + tranexamic acid (n=104), iron + placebo (n=103), tranexamic acid + placebo (n=103), and double placebo (n=103), with an interim analysis conducted on the first 390 participants. The primary outcome was the percentage of patients requiring blood transfusion during hospitalization or by day 30.

● The primary outcome, transfusion percentage, showed a decrease in the iron + tranexamic acid group (15%) compared to the double placebo group (30%), yielding a relative risk of 0.51 (98.3% CI 0.27−0.97; p=0.012).

● Similar transfusion rates were observed in the iron-only (26%) and tranexamic acid-only (27%) groups.

● Adverse event rates were comparable across groups, with common events such as sepsis, pneumonia, and urinary infections.

This study suggests that combining ferric derisomaltose (intravenous iron) and tranexamic acid can significantly reduce the risk of blood transfusion by 50% in patients undergoing hip fracture surgery.

The combination approach highlights the potential benefits of integrating treatments from different therapeutic approaches to improve patient outcomes.

While neither treatment alone showed a significant reduction in transfusion rates in this study, the combined effect proved promising.

These findings contribute to the understanding of blood-management strategies for patients undergoing hip fracture surgery. Further research and larger trials are needed to confirm these results and explore the broader applicability of this combination treatment approach. The study underscores the importance of innovative strategies to enhance patient care and recovery in orthopedic surgery.

Reference:

Lasocki, S., Capdevila, X., Vielle, B., Bijok, B., Lahlou-Casulli, M., Collange, V., Grillot, N., Danguy des Deserts, M., Duchalais, A., Delannoy, B., Drugeon, B., Bouzat, P., David, J.-S., Rony, L., Loupec, T., Léger, M., Rineau, E., Bouhours, G., Lasocki, S., … David, J.-S. (2023). Ferric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial. The Lancet. Haematology. https://doi.org/10.1016/s2352-3026(23)00163-1