Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Document Type : RESEARCH PAPER


1 Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Poursina hospital, Rasht, Iran

2 Guilan University of Medical Sciences (GUMS), Orthopedic Research Center, Poursina hospital, Rasht, Iran

3 Guilan University of Medical Sciences (GUMS) Anesthesiology, Research Center, Poursina hospital, Rasht, Iran

4 Guilan University of Medical Sciences, Rasht, Iran


Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to
postoperative acute anemia and some other complications.
Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion
requirements during some elective surgeries (1-3).
The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a
subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.
Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary
nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group
I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision.
Patients in the placebo group received an identical volume of normal saline.
Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin
change as well as transfusion rates and volumes were compared between the two groups.
Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,
respectively (
). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group
(5.6%) compared to the placebo group (30%) (
). No significant difference in The Allowable Blood Loss during the
surgery was found between the two groups (
Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during
traumatic femoral fracture operation.


Main Subjects

1. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ,
Fergusson DA, et al. Anti-fibrinolytic use for minimising
perioperative allogeneic blood transfusion. Cochrane
Database Syst Rev. 2011; 16(3):CD001886.
2. Kim C, Park SS, Davey JR. Tranexamic acid for the
prevention and management of orthopedic surgical 
hemorrhage: current evidence. J Blood Med. 2015;
3. Keyhani S, Esmailiejah AA, Abbasian MR, Safdari F.
Which route of tranexamic acid administration is
more effective to reduce blood loss following total
knee arthroplasty? Arch Bone Jt Surg. 2016; 4(1):65-9.
4. Soleimanha M, Haghighi M, Mirbolook A, Sedighinejad
A, Mardani-Kivi M, Naderi-Nabi B, et al. A survey on
transfusion status in orthopedic surgery at a trauma
center. Arch Bone Jt Surg. 2016; 4(1):70-4.
5. Lin SY, Chen CH, Fu YC, Huang PJ, Chang JK, Huang
HT. The efficacy of combined use of intraarticular
and intravenous tranexamic acid on reducing blood
loss and transfusion rate in total knee arthroplasty. J
Arthroplasty. 2015; 30(5):776-80.
6. Vijay BS, Bedi V, Mitra S, Das B. Role of tranexamic acid
in reducing postoperative blood loss and transfusion
requirement in patients undergoing hip and femoral
surgeries. Saudi J Anaesth. 2013; 7(1):29-32.
7. Wong J, El Beheiry H, Rampersaud YR, Lewis S, Ahn H,
De Silva Y, et al. Tranexamic Acid reduces perioperative
blood loss in adult patients having spinal fusion
surgery. Anesth Analg. 2008; 107(5):1479-86.
8. Keating EM, Meding JB. Perioperative blood
management practices in elective orthopaedic
surgery. J Am Acad Orthop Surg. 2002; 10(6):393-400.
9. Noordin S, Waters TS, Garbuz DS, Duncan CP, Masri
BA. Tranexamic acid reduces allogenic transfusion in
revision hip arthroplasty. Clin Orthop Relat Res. 2011;
10. Soleimanha M, Sedighinejad A, Haghighi M, Nabi BN,
Mirbolook AR, Mardani-Kivi M. Hemodynamic and
arterial blood gas parameters during cemented hip
hemiarthroplasty in elderly patients. Arch Bone Jt
Surg. 2014; 2(3):163-7.
11. Foss NB, Kehlet H. Hidden blood loss after surgery for
hip fracture. J Bone Joint Surg Br. 2006; 88(8):1053-9.
12. Wind TC, Barfield WR, Moskal JT. The effect of
tranexamic acid on blood loss and transfusion rate in
primary total knee arthroplasty. J Arthroplasty. 2013;
13. Rannikko A, Petas A, Taari K. Tranexamic acid in 
control of primary hemorrhage during transurethral
prostatectomy. Urology. 2004; 64(5):955-8.
14. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista
R, Caballero J, Coats T, et al. Effects of tranexamic acid on
death, vascular occlusive events, and blood transfusion
in trauma patients with significant haemorrhage
(CRASH-2): a randomised, placebo-controlled trial.
Lancet. 2010; 376(9734):23-32.
15. Turpie AG, Eriksson BI, Bauer KA, Lassen MR. New
pentasaccharides for the prophylaxis of venous
thromboembolism: clinical studies. Chest. 2003;
124(6 Suppl):371S-8.
16. Sethna NF, Zurakowski D, Brustowicz RM, Bacsik
J, Sullivan LJ, Shapiro F. Tranexamic acid reduces
intraoperative blood loss in pediatric patients
undergoing scoliosis surgery. Anesthesiology. 2005;
17. Dunn CJ, Goa KL. Tranexamic acid: a review of its
use in surgery and other indications. Drugs. 1999;
18. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT.
Tranexamic acid to reduce blood loss after bilateral
total knee arthroplasty: a prospective, randomized
double blind study. J Arthroplasty. 2011; 26(1):24-8.
19. Crescenti A, Borghi G, Bignami E, Bertarelli G,
Landoni G, Casiraghi GM, et al. Intraoperative use of
tranexamic acid to reduce transfusion rate in patients
undergoing radical retropubic prostatectomy: double
blind, randomised, placebo controlled trial. BMJ.
2011; 343:d5701.
20. 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.
2010; 104(1):23-30.
21. Rasouli MR, Parvizi J. Tranexamic Acid in total joint
arthroplasty: efficacy and safety. Arch Bone Jt Surg.
2015; 3(1):1-2.
22. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti
MR, Malkani AL. Comparison of intravenous versus
topical tranexamic acid in total knee arthroplasty: a
prospective randomized study. J Arthroplasty. 2014;