Faculty Advisor(s)

Maribeth Massie

John Hanlon

Document Type

Capstone

Publication Date

5-2017

Rights

© 2017 Katherine Balzano-Cowan and Morgan Guerrette

Abstract

Minimizing perioperative blood loss during orthopedic surgery has proven challenging for providers. Perioperative utilization of antifibrinolytic pharmacologic interventions, such as tranexamic acid (TXA), has been demonstrated as a safe and effective technique for decreasing blood loss and allogenic blood transfusion rates. Currently, the Food and Drug Administration (FDA) approved on-label indications of TXA are for use in short-term treatment of hemophilia patients undergoing dental extractions and in management of patients experiencing menorrhagia (Mayeux, Alwon, Collins, & Hewer, 2016). Despite the current limited scope of FDA approval for TXA, use in elective surgery with otherwise clotting-uncompromised patients is not a new concept. Perioperative TXA administration in elective joint replacement surgery, cardiopulmonary bypass, spinal fusions, and hysterectomies has been well studied (Duncan et al., 2015). Numerous studies have acknowledged TXA use decreases perioperative blood loss, decreases perioperative blood transfusions, and shortens length of hospital stay. Additionally, research exists that demonstrates safety and efficacy of TXA use in patients presenting with traumatic injury (Roberts et al., 2013). Despite this vast body of knowledge, little research exists evaluating TXA use in hip fractures. Over 325,000 traumatic hip fractures occur every year (Neuman, Rosenbaum, Ludwig, Zubizarreta, & Silber, 2014). This patient population is generally frail and typically lacks optimization prior to urgent surgery. Based on the extensive body of prior research conducted to date, it is reasonable to postulate that TXA use in these instances would yield a decreased blood loss and therefore contribute to lower rates of allogenic blood transfusion in hip fracture patients.

Comments

Master's capstone

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