Effect Of TXA On Reducing Perioperative Hidden Blood Loss In Inter-trochanteric Fracture Treated With PFNA

Objective:To investigate the effect of tranexamic acid(TXA)on reducing perioperative hidden blood loss in inter-trochanteric fracture treated with proximal femoral nail anti-rotation(PFNA)Methods:A prospective,randomized,controlled clinical trail was conducted on 90 patients with inter-trochanteric fracture treated with proximal femoral nail anti-rotation according to the inclusion and exclusion criteria in our hospital.All patients were divided into three groups according to the administration and frequency,with 30 cases in each group.Patients in the control group(Group A)received saline at a dose of 100ml intravenously1 hour preoperatively and 5 hours postoperatively.Patients in the single administration group(Group B)received 15mg/kg of tranexamic acid with 100ml saline intravenously 1 hour preoperatively and saline at a dose of 100ml intravenously 5 hours postoperatively.Patients in the twice administration group(Group C)received 15mg/kg of tranexamic acid with 100ml saline intravenously 1 hour preoperatively and 5 hours postoperatively.Group A included 14 males and 16 females,and the age was(71.23±15.57)years.Group B included 16 males and 14 females,and the age was(68.40±17.46)years.Group C included 15 males and 15 females,and the age was(77.37±11.70)years.Perioperative data including operation time,intraoperative blood loss,postoperative blood loss,theoretical blood loss,hidden blood loss,postoperative hemoglobin and hematocrit drop,postoperative transfusion volume and transfusion rate,postoperative hospitalization time and postoperative complications were compared between three groups.Results:1.There were no statistically significant differences in patients’general characteristics such as age,gender,body mass index,Evens-Jensen classification and admission-operation period between three groups(P>0.05).There were no statistically significant differences in patients’preoperative haemocytes parameters characteristics such as red blood cell,hemoglobin,hematocrit,platelet and coagulation parameters characteristics such as PT,APTT,TT,FIB between three groups(P>0.05).2.The operation time was(76.87±18.75)minutes in Group A,(80.87±17.47)minutes in Group B and(70.53±20.30)minutes in Group C(PA-B>0.05,PA-C>0.05,PB-C>0.05).The intraoperative blood loss was(135.3±39.28)ml in Group A,(129.0±41.47)ml in Group B and(113.0±42.76)ml in Group C(PA-B>0.05,PA-C>0.05,PB-C>0.05).The postoperative drainage volume was(125.3±36.24)ml in Group A,(93.17±35.17)ml in Group B and(59.50±14.93)ml in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The theoretical blood loss was(1098±312.9)ml in Group A,(840.0±243.7)ml in Group B and(480.0±1 16.9)ml in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The hidden blood loss was(837.8±307.7)ml in Group A,(617.8±235.1)ml in Group B and(308.3±110.1)ml in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The postoperative hemoglobin drop was(27.73±9.377)g/L in Group A,(21.67±8.953)g/L in Group B and(13.37±6.283)g/L in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The postoperative hematocrit drop was(8.613±2.472)%in Group A,(6.867±2.291)%in Group B and(4.103±1.457)%in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The postoperative transfusion volume was(233.3±190.6)ml in Group A,(130.0±202.0)ml in Group B and(20.00±80.52)%in Group C(PA-B<0.05,PA-C<0.05,PB-C<0.05).The postoperative transfusion rate was 70%in Group A,33.33%in Group B and 6.67%in Group C(PA-B<0.05,PA-C<0.05.PB-C<0.05).The postoperative hospitalization time was(8.100±2.294)days in Group A,(7.467±3.060)days in Group B and(7.833±2.276)days in Group C(PA-B>0.05,PA-C>0.05,PB-C>0.05).3.Moreover,no deep vein thrombosis,pulmonary embolism or cutaneous necrosis occurred in each group.There were no significant differences in the incidence of side effects of tranexamic acid,intramuscular venous thrombosis or wound infection between three groups(PA-B>0.05,PA-C>0.05,PB-C>0.05).Conclusions:The effect and safety of tranexamic acid on reducing perioperative hidden blood loss in inter-trochanteric fracture patients treated with PFNA are confirmed at the routine dose of administration(15mg/kg).Compared with the single administration of tranexamic acid,the twice administration is more effective in controlling perioperative hidden blood loss,which is worthy of clinical application.