The effect of tranexamic acid on blood loss in non-urgent trauma patients undergoing major orthopaedic surgery: A retrospective cohort study

Objectives: This study aims to clarify the role of prophylactic TXA on blood loss and transfusion requirements in a subgroup of trauma patients undergoing major orthopaedic surgery on a non-urgent basis. Study design: This is a retrospective cohort study. Setting: Tertiary University Hospital of Crete (2017-2018) Patients/participants: Polytrauma patients who underwent delayed major orthopaedic surgery Main outcome measurement: Significant haemorrhage occurrence in relation to TXA administration. In a subgroup of patients Rotational Thromboelastometry (ROTEM) was used to reveal their haemostatic profile prior to TXA administration. Methods: Data from anaesthetic and ICU records were analyzed regarding age, sex, body mass index, ASA physical status, Injury Severity Score, Caprini Score, intraoperative blood loss, number of packed red blood cells units transfused, volume of crystalloids administered, operation duration, preoperative and postoperative haemoglobin values, and days from hospital admission to surgery. ROTEM analysis in a subgroup of patients revealed their haemostatic profile prior to TXA administration. Results: Twenty five out of 46 patients received prophylactic TXA treatment. After adjustment for confounding factors, the odds ratio for the composite endpoint for prophylactic TXA (n=25) vs no TXA (n=21) was 1.27 (95% confidence interval, CI 0.39-4.16). Propensity matched analysis confirmed the absence of a difference between patients with and without TXA. In all patients analyzed with ROTEM normal or hypercoagulable status was revealed. Conclusions: In trauma patients undergoing major orthopaedic surgery more than 12 hours after the initial injury, TXA has no effect on blood loss and transfusion requirements.