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BJA Advance Access published online on November 18, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep314
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Tranexamic acid in hip fracture surgery: a randomized controlled trial

P. J. Zufferey1,2,*, M. Miquet1, S. Quenet2, P. Martin1, P. Adam3, P. Albaladejo4, P. Mismetti2, S. Molliex1 and for the investigators of the tranexamic acid in hip-fracture surgery (THIF) study{dagger}

1 Department of Anaesthesiology and Intensive Care and
2 Department of Clinical Pharmacology, University Hospital of Saint-Etienne, Thrombosis Research Group, EA3065 France.
3 Department of Orthopaedic Surgery, University Hospital Bellevue, St-Etienne, France.
4 Department of Anaesthesiology and Intensive Care, University Hospital of Grenoble, Grenoble, France

* Corresponding author: Department of Anaesthesiology and Intensive Care, University Hospital of Saint-Etienne, 42055 Saint-Etienne Cedex 02, France. E-mail: paul.zufferey{at}chu-st-etienne.fr

Background: Hip fracture surgery may be associated with substantial blood loss. This study was designed to assess the efficacy and safety of the use of tranexamic acid in hip fracture surgery for the reduction of erythrocyte transfusion.

Methods: The study pertains to a randomized double-blind study with blinded adjudication of outcomes. Patients requiring surgery for an isolated hip fracture of less than 48 h received saline or tranexamic acid 15 mg kg–1 given at skin incision and 3 h later. Primary efficacy outcome was erythrocyte transfusion from surgery up to day 8. Transfusion was administered according to a standardized protocol (Hb<9 g dl–1). Safety criterion was a composite of symptomatic and asymptomatic vascular events up to 6 weeks.

Results: Fifty-seven patients were randomized to tranexamic acid and 53 to placebo. The rate of erythrocyte transfusion was 42% with tranexamic acid and 60% with placebo (P=0.06). Preoperative haemoglobin value, age, and type of surgery were risk factors for erythrocyte transfusion independent of treatment group. The probability of vascular events at 6 weeks was 16% in the tranexamic acid group and 6% in the placebo group (P=0.10). A meta-analysis combining this study with previous trials showed that tranexamic acid significantly reduced erythrocyte transfusion in hip fracture surgery although efficacy was lower than that observed in hip or knee arthroplasty.

Conclusions: In hip fracture surgery, tranexamic acid reduces erythrocyte transfusion but may promote a hypercoagulable state. Thus, further evaluation of safety is required before recommending the off-label use of tranexamic acid.

Keywords: blood; complications, thrombosis; pharmacology, blood loss; surgery, orthopaedic; transfusion

{dagger} See Acknowledgements.


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