Relationship between blood loss of proximal femoral nail anti-rotation fixation and local use combined with intravenous injection of tranexamic acid / 中国组织工程研究

ABSTRACT

BACKGROUND: Tranexamic acid has been shown to effectively reduce dominant and hidden blood loss in patients undergoing proximal femoral nail antirotation fixation, and it is safe and effective. At present, the use of tranexamic acid in this operation is mainly divided into intravenous infusion and local intramedullary perfusion; intravenous infusion can be divided into single use or multiple uses, and most of the local use is single use. For the combined local use with intravenous infusion is rarely reported. However, the combined use of tranexamic acid in hip and knee arthroplasties has been proven to be safe and effective. OBJECTIVE: To explore the effectiveness and safety of intravenous combined with local application of tranexamic acid on the perioperative blood loss in proximal femoral nail antirotation. METHODS: Ninety patients with intertrochanteric fracture who underwent proximal femoral nail antirotation in Shantou Hospital of Traditional Chinese Medicine from January 2016 to December 2018 were enrolled, and randomly divided into combined, intravenous and local groups (n=30/group). All patients signed the informed consents and the study was approved by the hospital ethical committee. In the combined group, tranexamic acid (20 mg/kg dissolved in 20 mL normal saline) was injected intravenously at 30 minutes before surgery, followed by femoral intracavitary injection of tranexamic acid (1 g, dissolved in 20 mL normal saline) after proximal femoral nail antirotation. Intravenous group only underwent intravenous injection of tranexamic acid. Local group only received femoral intracavitary injection of tranexamic acid. The total blood loss, dominant blood loss, hidden blood loss, International Normalized Ratio, prothrombin time, activated partial thromboplastin time, blood transfusion rate and the incidence of deep venous thrombosis were counted and compared in the three groups. RESULTS AND CONCLUSION: (1) The total blood loss in the combined group was significantly less than that in the intravenous and local groups (P 0.05). (2) The hidden blood loss in the combined group was significantly less than that in the intravenous and local groups (P 0.05). (3) There was no significant difference in the dominant blood loss among groups (P > 0.05). (4) The International Normalized Ratio, prothrombin time, and activated partial thromboplastin time before and after surgery showed no significant difference among groups (P > 0.05). (5) The blood transfusion rate showed no significant difference among groups (P > 0.05). (6) None presented with deep venous thrombosis. (7) These results suggest that compared with single intravenous and intracavitary injection of tranexamic acid, their combination can obviously reduce total and hidden blood loss of proximal femoral nail antirotation without increasing the risk of deep venous thrombosis. In addition, single intravenous and intramedullary injection of tranexamic acid has no significant difference in total or hidden blood loss.