Topical Tranexamic Acid (TXA) in Hip Fractures

The results of this study may dramatically alter the manner in which surgeons manage hip fracture patients in Canada. The use of topical TXA in operatively-treated hip fracture patients has the potential to reduce perioperative blood loss and consequently reduce exposure to allogeneic blood transfusion. This will positively influence post-operative morbidity and mortality, while at the same time substantially reduce hospital length of stay and overall health care costs. The proposed study is felt to have minimal risk, and is a relatively inexpensive study.

Update: An interim analysis was completed in January 2018. The Data Safety Monitoring Committee reviewed the results and recommend the trial continue as planned.

The final data analysis is in process. The abstract will be uploaded upon completion.

Inclusion criteria

All of the following criteria must be met to be eligible:

• 18 years of age or older
• Diagnosis of hip fracture (Intracapsular, Intratrochanteric or Subtrochanteric) requiring surgical repair
• Patient/surrogate decision maker provide signed informed consent

Exclusion criteria

Participants cannot be included in this study if any of the following criteria apply:

• Patient has documented renal failure with glomerular filtration rate of <30ml/min/1.73m2
• Documented allergy to tranexamic acid
• Current use of hormone replacement therapy
• Acquired disturbances of colour vision
• Refusal of blood products
• Pre-operative use of anticoagulant therapy (Coumadin, heparin < 5 days of surgery, fibrinolytic disorders requiring intraoperative anti-fibrinolytic treatment)
• Coagulopathy (pre-operative platelet count <150,000/mm3, International Normalized Ratio (INR) >1.4, prolonged Partial Thromboplastin Time (PTT) >1.4x normal)
• Hematuria
• Acute coronary syndrome within 6 weeks of fracture
• Any history of venous thromboembolism
• Any intraoperative surgical/medical/anesthetic complications i.e.: myocardial infarction or neurovascular injury occurring prior to application of the tranexamic acid
• Pregnant or lactating
• Any major medical or psychiatric disorder that in the opinion of the investigator, might prevent the subject from completely participating in the study or interfere with the interpretation of the study results
• Unable/unwilling to provide informed consent