Effect Of Topical Application Of Tranexamic Acid On Postoperative Bleeding Of Calcaneal Fractures

Objective:The purpose of this study was to evaluate the role of topical administration of tranexamic acid in reducing postoperative blood loss in calcaneal fractures,,as well as the effects on coagulation and postoperative complications.Methods:A prospective randomized controlled study was conducted on 40 patients diagnosed with calcaneal fractures(Sanders type Ⅰ to type Ⅳ)and open reduction and internal fixation in our hospital from September 2017 to December 2019.In principle,40 patients were randomly divided into an experimental group(group A)and a control group(group B),20 cases in each group.All patients underwent open reduction and internal fixation of calcaneal fractures via the lateral"L" approach and the operation method was the same in all cases.15-30min before the operative tourniquet,the surgical wound was irrigated with 80ml 0.5g/L tranexamic acid in the TXA group and 80ml 0.9%sodium chloride in the control group,followed by the routine use of a drainage tube before close of the incision.Then 20ml 0.5g/L tranexamic acid(TXA group)or 20ml 0.9%sodium chloride solution(control group)was injected retrogradely into the wound through the drainage tube,which was clipped for 30 minutes after that.A drainage bottle was used to record the volume of drainage.Observe the drainage volume and its cumulative value at 6 hours,12 hours,18 hours,24 hours,30 hours,36 hours,42 hours,and 48 hours after operation,compare the coagulation function before operation and the coagulation function at 48 hours after operation,and whether there is postoperative complication.Observe the drainage volume at 6 hours,12 hours,18 hours,24 hours,30 hours,36 hours,42 hours,48 hours after operation and the accumulated value after 48 hours.The changes of coagulation function before operation and 48 hours after operation and postoperative complications were compared between the two groups.Results:There were no statistical difference in age,sex,height,weight,hemoglobin content,platelet count,prothrombin time(PT),and activated partial thromboplastin time(APTT)between the two groups before operation(P>0.05).Blood loss in the first 24 hours and total blood loss postoperation were statistically less in the TXA group(P<0.01).There was no statistically significant difference in prothrombin time and activated partial thrombin activity time between group A and group B(P>0.05).The surgical wounds healed well after surgery in both groups.No complications such as wound problems,thrombosis,acute myocardial infarction or allergic reactions occurred after surgeryConclusion:We concluded that topical application of tranexamic acid in calcaneal fracture surgeries is a safe and useful method,which can reduce postoperative blood loss,with no interference to the coagulation function and postoperative complications.