Tranexamic acid may decrease red blood cell transfusion need in hip fracture surgery

Hip fracture is common in older adults due to osteoporosis. There is acute blood loss both due to injury and surgery. Older patients also have a greater risk of anaemia and may require blood transfusion also in their treatment. Allogenic blood transfusions (ABT) may be given before, during, and after surgery to correct chronic anaemia or acute blood loss. Still, there is uncertainty regarding the benefit‐risk ratio for ABT. The risks involved are infections, a longer stay in the hospital, etc.

In the present study, researchers aimed to find therapeutic modalities to reduce the need for a blood transfusion and pharmacological and non‐pharmacological interventions to minimise additional blood loss. They also wanted to find out the association of treatment with quality of life, side effects, etc.

The systemic review was researched for treatments to reduce blood loss in hip fracture patients.

The summary of this review is given below:

• There were 17 reviews about tranexamic acid and nine reviews about iron.
• A total of 36 studies and 3923 participants were included.
• Patients were given tranexamic acid before, during, or after surgery, either intravenously or topically.
• For iron, treatment was given intravenously.

For tranexamic acid:

• The tranexamic acid reduces the need for a blood transfusion. For every 1000 hip fracture patients, 257 do not require a blood transfusion.
• The tranexamic acid probably reduces the volume of transfused PRC.
• There were no reported postoperative delirium, ADL, or quality-of-life outcomes.

For iron:

• There were nine reviews, seven eligible RCTs
• There may be little or no difference according to whether intravenous iron was given in: the number of people who required ABT, the volume of transfused blood, infection or mortality within 30 days.
• Researchers did not report little or no difference in delirium.
• No reviews reported outcomes of cognitive dysfunction, ADL, or HRQoL.

They said that using tranexamic acid before, during, or after hip fracture surgery reduces the need for a blood transfusion.

Treatment with iron may make little to no difference to whether people need a blood transfusion following hip fracture surgery.

Further reading:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013737.pub2/full