Key result
Sequential intravenous tranexamic acid significantly reduced preoperative hidden blood loss compared to control or single-dose TXA, while adding iron supplements with or without rHuEPO provided no additional clinical benefit.
Why the study?
Research on preoperative blood management in elderly patients with delayed intertrochanteric fracture surgery was scarce, especially regarding hematopoiesis and hemostasis.
Does sequential intravenous tranexamic acid, with or without iron supplements and rHuEPO, reduce preoperative hidden blood loss and transfusion rates in elderly patients with delayed intertrochanteric fracture surgery?
Cohort (n=456)
No
Does sequential intravenous tranexamic acid, with or without iron supplements and rHuEPO, reduce preoperative hidden blood loss and transfusion rates in elderly patients with delayed intertrochanteric fracture surgery?
Sequential intravenous tranexamic acid reduces preoperative hidden blood loss and hospitalization duration in elderly patients with delayed intertrochanteric fracture surgery, but adding iron supplements with or without rHuEPO provides no additional clinical benefit.
Sequential IV TXA was associated with reduced hidden blood loss in delayed intertrochanteric fractures; hypothesis-generating and should not change practice without RCT confirmation.
Research on preoperative blood management in the elderly with delayed intertrochanteric fractures surgery is scarce, especially in hematopoiesis and hemostasis. We aimed to assess the effectiveness of the optimized blood management program in elderly patients with delayed intertrochanteric fractures surgery. This retrospective study included 833 patients with intertrochanteric fractures after delayed surgery. According to the actual optimized blood management plan, they were divided into four groups: Group A was the control group; Group B received 1 g of IV TXA at admission; group C underwent sequential TXA treatment after admission until 1 d before surgery (1 g/d); group D received iron supplements (200 mg/d) in addition to the treatment administered to group C, with or without recombinant human erythropoietin (rHuEPO; 40,000 IU). The primary outcomes were preoperative hidden blood loss (HBL), preoperative allogeneic blood transfusion (ABT) rate, hemoglobin (Hb) change, and actual Hb drop. The Hb reduction, calculated HBL, and hospitalization duration in groups C and D were significantly lower than those in groups A and B. The preoperative ABT rates in groups C and D were significantly lower than those in groups A and B, but there was no statistical difference between groups C and D. In conclusion, this study suggested that the iron supplement (with or without rHuEPO) combined with sequential intravenous tranexamic acid (IV TXA) scheme did not show a better clinical effect than sequential IV TXA scheme in management of patients with delayed intertrochanteric fractures surgery. Therefore, before recommending iron supplements and rHuEPO in elderly patients, further evaluation is needed.
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Cui et al. (2022) conducted a cohort in Delayed intertrochanteric fractures (n=456). Sequential intravenous tranexamic acid (IV TXA) with or without iron supplements and rHuEPO vs. Control (no TXA) or single-dose IV TXA (1 g) was evaluated on Preoperative hidden blood loss (HBL) in mL (p=<0.001). Sequential intravenous tranexamic acid significantly reduced preoperative hidden blood loss compared to control or single-dose TXA, while adding iron supplements with or without rHuEPO provided no additional clinical benefit.
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