Tranexamic Acid Reduces Transfusion Rates After Modular Hemiarthroplasty for Pathological Femoral Fractures: A Retrospective Study.

Abstract

Fractures of the femur are one of the major complications of solid tumor metastasis to bone. Tumor resection with reconstruction using modular prostheses achieves optimal local tumor control, pain reduction, and improved patient function and quality of life. Unfortunately, the surgical treatment of femoral fractures with prostheses is associated with high blood loss, requiring the transfusion of blood products. Blood transfusion carries several risks, including immune suppression and a higher risk of postoperative infection, deterioration of functional outcomes, and prolonged hospital stays. An inexpensive and effective way to reduce blood loss and the number of transfusions is tranexamic acid (TXA). In our study, we analyzed 82 cases of patients treated with resectional prostheses for pathological fractures between 2017 and 2021. The operations of 42 patients were performed between 2017 and 2019 without the use of TXA. Another 38 patients were operated on in 2020-2021 with the use of TXA prophylaxis. Total blood loss (TBL), hemoglobin drop, number of transfusions, and adverse thromboembolic events were evaluated. After surgery, patients who received TXA had higher hemoglobin levels on the first day than those in the control group (0.99 g/dL <i>p</i> = 0.03), and the blood loss was reduced by 217 mL in the TXA group (<i>p</i> = 0.09). Transfusion rate was reduced from 43% to 17% (<i>p</i> = 0.04). No differences were seen in the number of complications. TXA significantly reduced transfusion rates and hemoglobin drop, without increasing complications. ClinicalTrials.gov identifier: NCT06244498.