Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy

• Published in: Orthopedics (Thorofare, N.J.) Vol. 39; no. 1; pp. 44 - 48
• Main Authors: Bryan, Andrew J, Sanders, Thomas L, Trousdale, Robert T, Sierra, Rafael J
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.01.2016
• Subjects: Acids; Administration, Intravenous; Adolescent; Adult; Anesthesia; Antifibrinolytic Agents - administration & dosage; Aspirin - therapeutic use; Blood & organ donations; Blood Loss, Surgical - prevention & control; Blood Transfusion; Bone surgery; Disease prevention; Dissection; Epidural; Female; Fibrinolytic Agents - therapeutic use; Hemoglobin; Hemoglobins - metabolism; Hip Joint - surgery; Humans; Joint replacement surgery; Male; Medical personnel; Operative Time; Orthopedics; Osteotomy - adverse effects; Patients; Pulmonary Embolism - etiology; Pulmonary Embolism - prevention & control; Pulmonary embolisms; Surgeons; Thromboembolism; Thrombosis; Tranexamic Acid - administration & dosage; Venous Thrombosis - etiology; Venous Thrombosis - prevention & control; Young Adult
• ISSN: 0147-7447; 1938-2367
• DOI: 10.3928/01477447-20151222-10

Bernese (Ganz) periacetabular osteotomy is associated with significant blood loss and the need for perioperative transfusion. Tranexamic acid decreases blood loss and minimizes transfusion rates in total joint arthroplasty. However, no reports have described its use in patients undergoing Bernese periacetabular osteotomy. This study reports the use of intravenous tranexamic acid in these patients. The study included 137 patients (150 hips) who underwent isolated periacetabular osteotomy at a single institution between 2003 and 2014. Of these, 68 patients (75 hips) received intravenous tranexamic acid 1 g at the time of incision and 1 g at the time of closure. A group of 69 patients (75 hips) served as control subjects who underwent periacetabular osteotomy without administration of intravenous tranexamic acid. Thromboembolic disease was defined as deep venous thrombosis or pulmonary embolism occurring within 6 weeks of surgery. Outcomes measured included transfusion requirements, pre- and postoperative hemoglobin values, operative times, and thromboembolic disease rates. Aspirin was used as the thromboembolic prophylactic regimen in 95% of patients. The rate of allogeneic transfusion was 0 in the tranexamic acid group compared with 21% in the control group (Bernese (Ganz) periacetabular osteotomy is associated with significant blood loss and the need for perioperative transfusion. Tranexamic acid decreases blood loss and minimizes transfusion rates in total joint arthroplasty. However, no reports have described its use in patients undergoing Bernese periacetabular osteotomy. This study reports the use of intravenous tranexamic acid in these patients. The study included 137 patients (150 hips) who underwent isolated periacetabular osteotomy at a single institution between 2003 and 2014. Of these, 68 patients (75 hips) received intravenous tranexamic acid 1 g at the time of incision and 1 g at the time of closure. A group of 69 patients (75 hips) served as control subjects who underwent periacetabular osteotomy without administration of intravenous tranexamic acid. Thromboembolic disease was defined as deep venous thrombosis or pulmonary embolism occurring within 6 weeks of surgery. Outcomes measured included transfusion requirements, pre- and postoperative hemoglobin values, operative times, and thromboembolic disease rates. Aspirin was used as the thromboembolic prophylactic regimen in 95% of patients. The rate of allogeneic transfusion was 0 in the tranexamic acid group compared with 21% in the control group ( P =.0001). No significant difference was found in the autologous cell salvage requirement (.96 vs 1.01; P =.43) or the thromboembolic disease rate between the tranexamic acid group and the control group (2.67% vs 1.33%; P =.31). The use of intravenous tranexamic acid led to a decreased transfusion requirement with no increased risk of thromboembolic disease in this contemporary cohort of patients undergoing periacetabular osteotomy. [ Orthopedics. 2016; 39(1):44–48.]