Impact of Topical Tranexamic Acid on Pre- and Post-operative Hemoglobin/Hematocrit

  • STATUS
    Recruiting
  • End date
    Dec 30, 2025
  • participants needed
    98
  • sponsor
    University of Cincinnati
Updated on 17 May 2022

Summary

This multi-center, prospective study will evaluate the use of topical tranexamic acid (TXA - Cyklokapron; Pfizer, New York, NY) on pre-operative and post-operative hemoglobin (Hb)/hematocrit (Hct) in patients undergoing operative repair of isolated posterior wall (PW) acetabular fractures.

Description

In this prospective, randomized, double-blinded, multi-center study comparing topical TXA with placebo, investigators will determine whether topical TXA utilization in isolated PW acetabular surgery has beneficial or detrimental effects.

In order to evaluate the delta between pre-operative and post-operative hemoglobin (blood loss parameters) in patients with isolated PW acetabular fractures that were treated with topical TXA or a placebo, investigators will prospectively enroll all eligible patients with the diagnosis of a closed, isolated, PW acetabular fracture that requires surgical fixation. Isolated PW fractures have been chosen to reduce confounding variables, particularly those associated with more complex fracture patterns including longer surgery duration and blood loss.

Each subject will have a pre-operative Hb and Hct drawn on the morning of surgery to establish a baseline level. Prior to surgery, subjects will be computer-randomized by pharmacy to one of two groups: a topical TXA group and a control group. The topical TXA group will be treated with 2 gm/100 ml of normal saline, while the control group will be treated with a placebo (normal saline) in a similar fashion to the TXA experimental group.

The surgeon and the operative team will be blinded as to whether the patient receives TXA or placebo.

Intraoperative transfusion requirements and estimated blood loss (EBL) will be recorded for every patient.

Hemoglobin and hematocrit values will be obtained on postoperative day one and two with routine morning blood draws (typically 5 am-9 am). Post-operative transfusion requirements prior to discharge will be recorded. All patients will have standard low molecular weight heparin DVT prophylaxis for four weeks post-operatively.

Prospectively demographic data will be collected. Injury and treatment data collected will include date of injury, mechanism of injury, laterality of injury, medical co-morbidities, associated injuries, date of surgery, operative time, estimated operative blood loss (EBL) from both anesthesia and operative surgeon, calculated operative blood loss, as well as hemoglobin/hematocrit as described, and blood transfusions.

Details
Condition Fracture of Posterior Wall of Acetabulum
Treatment Normal saline, Tranexamic Acid
Clinical Study IdentifierNCT05357079
SponsorUniversity of Cincinnati
Last Modified on17 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Patients with an isolated, closed, posterior wall acetabular fracture managed surgically within 7 days of injury. Upper extremity fractures that are non-operative and have no impact on weight-bearing status will be included
Patients must be skeletally mature

Exclusion Criteria

Patients are not skeletally mature
Patients with any concomitant lower extremity, pelvis, or spine injuries
Patient admitted as a polytrauma patient to the trauma service due to injury to an internal organ (head, chest, or abdomen)
Patient has an unidentified source of hemorrhage other than acetabular fracture
Patient requires surgery for treatment of concomitant injuries
Patient requires multiple surgeries
Patient has pre-existing thrombus prior to surgery
Patient with a history of prior pulmonary embolus or other thromboembolic disease
Patient with a known bleeding disorder
Patient with a history of renal insufficiency
Patient who is unable to give consent or is unconscious
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