HiFIT Study : Hip Fracture: Iron and Tranexamic Acid

• Status: Active, not recruiting
• Trial end date: 2021-10-01
• Target enrollment: 0
• Participant gender: All

Summary

Fractures of the upper end of the femur, called commonly "Hip fractures" are very common, with an incidence of approximately 1.6 million cases per year worldwide. This high incidence is anticipated to grow rapidly in the next decades, driven by population aging. Anemia is very frequent on admission for hip fracture, concerning up to 45% of the patients, with a mean hemoglobin level of 12.5±0.2 g/dl. This high prevalence of anemia together with blood losses, secondary to the fracture itself and surgery are responsible for a high rate of blood transfusion (approximately 40-50% of the patients). However, both anemia and blood transfusion are associated with poor outcome, including increased mortality, length of stay, infection rate etc. In addition, blood is a scarce and expensive resource and its use should be limited as much as possible. There is therefore a need to treat this anemia and/or to prevent the decrease in hemoglobin. For this purpose, intravenous iron has been proposed. Some non-randomized, mainly retrospective, studies have shown that perioperative intravenous iron was able to reduce blood transfusion (i.e. the number of patients transfused and the number of units per patient). Another way to reduce blood transfusion would be to reduce perioperative bleeding. Tranexamic acid has proven to be efficient for this purpose both in trauma patients and in elective surgery patients.The interest for perioperative blood management has recently increased thanks to better recognition of the adverse effects of blood transfusion, better understanding of iron metabolism, new intravenous iron drugs and a renewed interest in former medications (i.e. tranexamic acid). HiFIT study therefore propose a 2X2 factorial design for this study in order to answer questions vis-à-vis the interest of iron and tranexamic acid to reduce blood transfusion in hip fracture patients.

• Phase: Phase 3
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University Hospital, Angers
• Treatments: Ferric Compounds; Iron; Iron isomaltoside 1000; Tranexamic Acid

Criteria

Inclusion Criteria:

• Age ≥ 18 years,

• Osteoporotic Fractures of the upper end of the femur requiring surgical repair.

• Preoperative hemoglobin between 9.5 and 13 g/dl.

• Patient or relative signed informed consent or inclusion thanks to urgent inclusion procedure

Exclusion Criteria:

• Bone marrow disease or ongoing treatment (such as chemotherapy), which could interfere with bone marrow erythropoiesis,

• Known allergy or counter-indication to iron and/or to tranexamic acid,

• Uncontrolled arterial hypertension,

• Recent iron infusion (within one week),

• Blood transfusion within one week before inclusion or preoperative blood transfusion already scheduled,

• Any patient who cannot be transfused or has refused consent for a blood transfusion,

• Bedridden or very dependent patient (equivalent to GIR 1 or 2 class).

• Non-affiliation to French health care coverage,

• Adult patient protected under the law (guardianship),

• Pregnancy.