This study examined whether administering tranexamic acid (TXA) before hip hemiarthroplasty surgery reduces postoperative blood transfusions. The study reviewed 271 patient records, with 84 patients receiving TXA and 187 not receiving it. Patients receiving TXA saw a lower drop in postoperative hemoglobin levels and lower transfusion rates. Specifically, the TXA group saw a 26% transfusion rate compared to 42% in the non-TXA group. The study concluded that TXA reduces postoperative blood loss and transfusions in hip hemiarthroplasty patients, and is a safe and cost-effective intervention.

1. Tranexamic acid in hip
hemiarthroplasty
Conrad Lee, Richard Freeman,
Mark Edmonson, Ben Rogers
Does it reduce blood loss and transfusion rates

2. Background
• Hip surgery is associated with intraoperative blood loss 1, 2
• Post operative anaemia have a negative impact on
functional recovery 2
• Blood transfusion has associated high costs and risks 3
• Hip fracture patients are most affected by postoperative
anaemia 2

3. Background
• Several blood conservation methods 4
• Tranexamic acid (TXA)
– antifibrinolytic
– Prevents conversion of plasminogen to plasmin
– Half-life 180 mins
– Most effective when given before hyperfibinolysis cased by
tissue injury during surgery
– 1g given intravenously as prophylaxis in RSCH (based on surgeon
preference)
• Much evidence for TXA use in elective THR / TKR 5, 6

4. Aim
• Does prophylactic TXA given before incision
reduce postoperative transfusion requirement
in hip hemiarthroplasty?
• Does it reduce postoperative haemoglobin
drop?

5. Methods
Consecutive hip
hemiarthroplasties for fractures
(June 2013 – Nov 2014)
Retrospective cohort study
Exclusion
• Blood transfusion within
3 days pre-op
• Incomplete data
• Austin Moore prosthesis
Data collected
• Demographics (age, gender, length of stay)
• Pre-morbid (mobility, AMTS, residence, antiplatelet/anticoag use)
• Surgery (ASA, anesthetic type, approach, surgeon grade)
• Bloods (pre / post op Hb)
• Transfusion requirements
• Mortality and morbidity
• Electronic
records
• National Hip
Fracture
Database
• Patient notes

6. PRIMARY OUTCOME
Blood (RBC) transfusion within 14 days of surgery
SECONDARY OUTCOMES
Significant reduction in haemoglobin (>20g/L) on day 1 post op
Clinical thromboembolic event
30 and 90 day mortality

7. Results
305 Hip hemi
271 eligible cases
186 female, 85 male
Mean age 85
34 cases exclude:
• 18 Austin Moore
• 10 Incomplete data
• 6 Pre-operative blood
transfusion
CASE (TXA)
N = 84
31%
CONTROL (No-TXA)
N = 187
69%

8. CASE (TXA)
N = 84
31%
CONTROL (No-TXA)
N = 187
69%
Cases matched:
Age, gender, mean pre-operative Hb, antiplatelet use, anticoagulation use,
pre-morbid residency, mobility, preoperative AMTS, anesthetic type, ASA
grade, surgical approach, surgeon grade*
22
62
hb drop
>20
hb drop
<20
79
108
26%
(n = 22)
42%
(n = 79)
P= 0.01
Day 1 Hb reduction

9. 6%
(n = 5)
18%
(n = 35)
P= 0.01
RBC
Transfusion
(n = 40)
Avg. no of units
per patient2.6 2.2
P= 0.43
1 in 16
1 in 5

10. 21 + 15.49 18 + 18.05P= 0.26
Length of stay
(days)
DVT /PE
Mortality
1 4P= 1.00
5% (n =4) 5% (n =9)P= 1.00
10% (n =8) 10% (n =19)P= 1.00
30 days
90 days

11. NNT = 8
1g TXA
£ 1.50
1 Unit RBC
£ 124.85
X-match
£ 15.97
~ £ 6312.62 saved per annum
if all patients given TXA

12. Discussion
• Data supports prior literature on blood conservative benefits
of TXA 5, 6
• Controversial safety profile 7
• Low VTE rates, mortality as surrogate
• Slight higher use of TXA in trauma fellows cases (14%)
• Limitations
– ?Selection bias

13. Conclusion
• TXA reduces postoperative Hb drop and
transfusion requirements in hip
hemiarthroplasties
• TXA is safe and cost effective
• Prophylactic TXA is recommended for patients
undergoing hip hemiarthroplasties

14. References
1. Zufferey PJ, Miquet M, Quenet S, Martin P, Adam P, Albaladejo P, et al. Tranexamic acid in hip fracture surgery: a
randomized controlled trial. Br J Anaesth [Internet]. 2010 Jan [cited 2015 Feb 2];104(1):23–30. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/19926634
2. Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL. Higher Hb level is associated with better
early functional recovery after hip fracture repair. Transfusion [Internet]. 2003 Dec [cited 2015 Feb
2];43(12):1717–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14641869
3. Kadar A, Chechik O, Steinberg E, Reider E, Sternheim A. Predicting the need for blood transfusion in patients with
hip fractures. Int Orthop [Internet]. 2013 Apr [cited 2015 Feb 4];37(4):693–700. Available from:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3609993&tool=pmcentrez&rendertype=abstract
4. Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br [Internet].
2008 Sep [cited 2015 Feb 2];90(9):1128–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18757950
5. Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, et al. Tranexamic acid use and postoperative
outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of
effectiveness and safety. BMJ [Internet]. 2014 Jan 12 [cited 2014 Dec 7];349(aug12_8):g4829. Available from:
http://www.bmj.com/content/349/bmj.g4829
6. Zhou X, Tao L, Li J, Wu L. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen
randomized controlled trials. Arch Orthop Trauma Surg [Internet]. 2013 Jul [cited 2015 Jan 4];133(7):1017–27.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/23615973
7. Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee
arthroplasty: a meta-analysis. Anaesth Intensive Care [Internet]. 2003 Oct [cited 2015 Jan 29];31(5):529–37.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/14601276