Intravenous tranexamic acid reduces blood loss and transfusion requirements after periacetabular osteotomy
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(2):7 Bone Joint J. 2020 Sep;102-B(9):1151-1157What this means for my practice?
The results of this study suggest that the use of IV TXA during PAO compared to saline can peri-operative reduce blood loss and the need for allogenic transfusions during PAO surgery. Yet, limitations of this study included the small sample size (n=81) as well as the limitations associated with estimating total blood loss. Therefore, future larger randomized controlled trials are required to confirm these findings to help orthopaedic surgeons determine best practices for PAO.
Study Summary
Eighty-one patients scheduled to undergo elective periacetabular osteotomy (PAO) were randomized to receive IV tranexamic acid (TXA; n=40) or intravenous (IV) normal saline (n=41). The primary outcome of interest was total peri-operative calculated blood loss. The secondary outcomes of interest included the incidence of allogeneic transfusion, length of hospital stay, incidence of complications at 6-weeks follow-up, and peri-operative cell saver usage. The results of this randomized controlled trial demonstrated that the primary outcome was statistically significantly reduced in the TXA group vs saline group (1,264.6 mL [SD 321.4] vs 1,515.4 mL [SD 393.9]; p=0.002). Furthermore, the incidence of allogenic transfusions was statistically significantly lower in the TXA group compared to the saline group (4 vs 15; p=0.008). All other outcomes were not statistically significantly different between the 2 treatment groups (p>0.05). Regression analysis was also conducted adjusting for factors including age, sex, BMI, pre-operative hemoglobin, cell-saver volume, peri-operative mean arterial pressure, and surgical time -- regression results suggested that using IV TXA was a predictor of lower calculated blood loss (p<0.001) and a negative predictor of allogenic transfusion use (p=0.007).
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