Anti Fibrinolytic RX for Jehovah Witness and Hip Fracture Patients

Morning Mist Bulgaria - photo by JoAnn Sturman

Scott Sturman, M.D.

Most TKA and THA patients now receive prophylactic tranexamic acid to minimize perioperative bleeding.  Anecdotally, the department has seen fewer transfusions and the need for fluid boluses to maintain blood pressure and urine output after surgery.   Anti fibrinolytic therapy is also used for other cases where significant blood loss is anticipated.

At a recent M&M conference a literature search demonstrated anti fibrinolytic RX as one of the few strategies where blood loss is actually reduced during surgery and trauma.

There are two additional sets of patients who should be considered for receiving tranexamic acid to reduce perioperative blood loss -- Jehovah Witness and hip fracture patients.  The former group should benefit especially from this treatment option due to the lack of therapeutic options in cases involving massive blood loss.

Hip fracture patients tend to be frail and elderly and at risk for fluid management problems.   By preemptively treating these patients with anti fibrinolyics, blood transfusions and crystalloid requirements should diminish, thereby reducing the chances of fluid overload in patients prone to heart failure.  Standardizing the use of tranexamic acid in this patient population should be considered.

Kalemedgan in Belgrade - photo by JoAnn Sturman