The Efficacy of Topical Tranexamic Acid in Femoral Neck Fractured Patients Undergoing Cemented Bipolar Hemiarthroplasty: A Randomized Double Blinded Controlled Trial

Abstract

Objective Tranexamic acid (TXA) is an antifibrinolytic that is widely used for decreasing blood loss and blood transfusion rates in total hip arthroplasty. However, there is limited evidence of topical TXA usage in hip hemiarthroplasty for femoral neck fractures. The present study aimed to evaluate the effects of topical TXA on blood loss and on blood transfusions in femoral neck fracture patients who underwent cemented bipolar hemiarthroplasty.

Methods Twenty-six patients with femoral neck fractures who were scheduled for bipolar cemented arthroplasty were randomized into two groups. The first group of 12 patients received topical TXA during their operation, whereas 14 patients in the second group received a placebo. Hematocrit was measured at 6 and 24 hours postoperatively. Blood transfusions and postoperative complications were also recorded.

Results Total blood loss was not different between the TXA group and the control group (TXA group: 459.48 ± 456.32 ml, and control group: 732.98 ± 474.02 ml; p = 0.14). However, there were no patients within the TXA group who required a blood transfusion, while there were 4 patients in the control group who received allogenic blood transfusions (p = 0.044). There were no postoperative complications, such as wound complication, venous thromboembolism, or cardiovascular complications within either group.

Conclusion Topical TXA could not decrease total blood loss but was able to reduce transfusion rates in patients who underwent cemented bipolar hip hemiarthroplasty in femoral neck fractures. Further studies in doses of topical TXA in a larger sample size would be beneficial.

Level of Evidence II.

Keywords

tranexamic acid - femoral neck fractures - hemiarthroplasty - arthroplasty, replacement, hip

Public Trials Registry

Thai Clinical Trials Registry (http://www.clinicaltrials.in.th): TCTR20201224005

Financing Source

Funding for the present research was provided by the Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (grant number 59–390–11–1). The funders had no role in the study design, data collection and analysis, decision to publish, nor in the preparation of the manuscript.

Contributions of the Authors

Hongnaparak T. designed the study, performed data collection, and performed the analysis and prepared the manuscript; Binlateh F. and Tanutit P. designed the study and performed data collection; Iamthanaporn K. designed the study and prepared the manuscript; Yuenyongviwat Y. designed the study, performed the analysis, and prepared the manuscript. All authors have read and approved the final manuscript.

Availability of Data and Materials

The datasets generated during the present study are available from the corresponding author upon reasonable request.

Work developed in the Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Publication History

Received: 25 June 2021

Accepted: 31 August 2021

Article published online:
20 December 2021

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