Tranexamic acid controls postoperative hidden blood loss in senile intertrochanteric fracture / 中国组织工程研究

ABSTRACT

BACKGROUND: In the elderly patients with intertrochanteric fractures, a large amount of hidden bleeding appears after surgery, so reducing hidden bleeding has become an important problem to be solved urgently. OBJECTIVE: To evaluate the effect of preoperative intravenous injection of tranexamic acid on the hidden blood loss after proximal femoral nail antirotation implantation. METHODS: Eighty-two cases of senile intertrochanteric fractures at Department of Traumatic Orthopedics of Guang’an People’s Hospital from July 2018 to July 2019 were selected, and all the patients underwent internal fixation with proximal femoral nail antirotation. The patients were allocated into two groups based on usage of tranexamic acid (n=41/group). In trial group, intravenous injection of tranexamic acid (10 mg/kg) was conducted during anesthesia, and control group was given the same volume of normal saline via vein. Blood routine examination was conducted at baseline and 1, 3 and 5 days postoperatively to count the level of hemoglobin and hematocrit. The total blood loss was calculated by Gross equation. The transfusion rate and postoperative incidence of thrombosis were recorded. RESULTS AND CONCLUSION: (1) There was no significant difference in the dominant blood loss between two groups (P > 0.05). (2) The perioperative actual total blood loss and postoperative hidden blood loss in the trial group were significantly lower than those in the control group (P < 0.05). (3) Three cases of blood transfusion (7%) in the trial group, and eight cases (24%) in the control group (P < 0.05). (4) No thrombosis occurred in both groups. (5) These findings suggest that preoperative intravenous infusion of tranexamic acid can effectively reduce the hidden blood loss after proximal femoral nail antirotation implantation, and does not increase the risk of postoperative thrombosis.