Tranexamic acid (TXA) is an inexpensive and easily administered drug that can be used to prevent or treat excessive blood loss after trauma or surgery. PenCLAHRC has previously been involved in the TXA in Trauma project, working with the South West Ambulance Service Trust (SWAST) to introduce the use of TXA in ambulance crews across the South West. As a result of this work, the procedure has now been rolled out across all ambulance services in England and is included in UK National Guidelines for the Joint Royal Colleges Ambulance Liaison Committee.
Surgical treatment of fragility hip fractures is challenging, being associated with high morbidity, mortality and significant cost that is mostly related to length of hospital stay, rehabilitation and social care. The majority of patients are elderly and frail, making them more susceptible to blood loss, with transfusions required in as many as 25% to 40% of cases. Complications associated with this include anaemia (deficiency of red blood cells) and hypovolemia (decreased volume of circulating blood in the body), as well as an increased risk of other problems such as infection and extended length of stay in hospital.
It is therefore important to reduce, as far as possible, blood loss and the need for blood transfusions during hip fracture surgery in order to improve outcomes for elderly patients. Whilst there is growing evidence to support the routine use of TXA in major elective orthopaedic surgery that includes more elderly and frail subgroups of patients, no definitive study has been carried out on the benefits and potential downsides of this drug in hip fracture care.
The project team seeks to establish whether treatment with TXA around the time of the operation improves the outcomes of elderly patients undergoing hip fracture surgery. The objectives are to:
- Understand the extent of the current use of TXA in hip fracture surgery
- Clarify whether use of the drug may be linked to reduced transfusion rates, improved recovery times and reduced stays in hospital
- Develop a study to evaluate the use of TXA in hip fracture surgery
The project team are addressing these objectives through a number of pieces of work:
Systematic review of literature
In order to address the lack of evidence around the use of TXA in hip fracture surgery, a systematic review of the available literature is being conducted with colleagues from the Evidence Synthesis Team.
Audit of hip fracture operation data
The team has conducted an audit of data from 618 hip fracture operations that took place in the Royal Devon & Exeter Hospital in 2014. This allowed identification of the types of fractures that are operated on and those that were most susceptible to requiring transfusion either during or after surgery.
Development of a study for evaluating TXA use in hip fracture surgery
The team are planning a study that would help them evaluate the use of TXA in hip fracture surgery, based on, amongst other outcomes, whether or not hip fracture patients require a blood transfusion within 7 days of surgery, the amount of transfused blood, the occurrence of blood clots in the vein and mortality within 90 days of surgery. A funding application will be developed to support the conduct of a research trial.