Study The Effect Of The Tranexamic Acid Administration Route On Perioperative Hidden Blood Loss In Elderly Intertrochanteric Femoral Fracture

Objective: Study the effect of the tranexamic acid administration route on perioperative hidden blood loss in elderly intertrochanteric femoral fracture with PFNA.Methods: The elderly patients with an intertrochanteric femoral fracture who received PFNA in Chaohu Hospital of Anhui Medical University between June 2020 and May2022 were prospectively studied,and eligible patients were completely randomized on admission into groups Ⅰ(n=33),Ⅱ(n=32),Ⅲ(n=26),and Ⅳ(n=31),for a total of 122 cases.Group Ⅰ was the control group: tranexamic acid was not applied,10 ml NS was injected intraoperatively into the medullary cavity and 10 ml NS was injected locally before closing the incision.Group Ⅱ was the intraoperative local administration group:2g TXA+20ml NS was mixed and divided into two equal parts,which were injected into the medullary cavity after reaming,and injected into the local soft tissue before closing the incision.Group Ⅲ was the group administered intravenously:tranexamic acid(1g TXA+100ml NS)was administered intravenously before skin incision and tranexamic acid(1g TXA+100ml NS)was administered intravenously 6 hours after surgery.Group Ⅳ was the combined administration group:1g TXA+100ml NS was used for intravenous drip before skin incision,and 1g TXA+20ml NS were mixed and divided into two equal parts,which were injected into the medullary cavity after reaming,and injected into the local soft tissue before closing the incision.The basic information of all patients was registered,including gender,age,height,weight,whether combined with hypertension,excluding no statistical differences.Blood routine was rechecked at admission and 1,3,and 5 days after surgery,and the amount of explicit blood loss was recorded intraoperatively and postoperatively to calculate and compare the hidden blood loss.Results: General information(gender,age,BMI,whether combined with hypertension,and duration of operation)was not statistically significant among the four groups,and the patients in group Ⅳ had significantly less significant bleeding than the remaining three groups,which was statistically significant(P < 0.0001).After comparing the HB and HCT of patients in the four groups at the time of admission,there was no statistical significance(P > 0.05),and the difference between the HB and HCT of 1,3,and 5 days after surgery was statistically significant(P < 0.0001).The postoperative HB and HCT in groups Ⅱ and Ⅲ were significantly higher than those in group Ⅰbut decreased less in group Ⅳ,The hidden blood loss was statistically significant among the four groups after calculation(P<0.0001).The amount of hidden blood loss during the perioperative period in the four groups was respectively are1101 ml,800ml,807 ml,and 698 ml.The hidden blood loss in group Ⅳ was less than that in the other three groups,indicating that intraoperative local application of TXA combined with intravenous application of TXA could reduce more recessive blood loss.The number of patients with thrombosis was recorded during the follow-up.There was one thrombus in group Ⅰ,no thrombus in group II,two thrombi in group Ⅲ,and one thrombus in group Ⅳ,and the difference was not statistically significant(P>0.05).Conclusion: Both intravenous and intraoperative topical TXA reduce perioperative HBL,and combining topical TXA with intravenous TXA reduced perioperative blood loss and HBL reduction is more obvious.There was no increased risk of blood clots after surgery.We recommend that topical combined intravenous TXA can be used to reduce HBL in patients with IFF during the perioperative period.