Invited Commentary related to: Tranexamic Acid Safely Reduced Blood Lossin Hemi- and Total Hip Arthroplasty for Acute Femoral Neck Fracture

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This is indeed a very well-written article. They set out to prove that tranexamic acid reduces blood lose and reduces transfusion rates in femoral neck fractures treated with a joint replacement (Hemi or Total Hip replacement).
Their power analysis and statistical analysis, although performed very well, assumed a difference in transfusion rate which just did not appear in their clinical trial. This left them with a very interesting data set, but one that was underpowered with respect to transfusion rates. This study could not show a significant difference in transfusion rates with the use of tranexamic acid but did show it reduced blood lose in this patient group.
Most significant studies look at primary outcomes that include a loss of 2 g of hemoglobin or a transfusion rate difference that is statistically significant. Future studies, based on this article, will require 350 patients in each group to arrive at a “significant difference conclusion,” if indeed one exists.
Despite these shortcomings, they did a huge amount of clinical work that will help others design future studies, and they should be congratulated for their work.

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