Abstract: BACKGROUND: Intertrochanteric fracture of femur often occurs in the elderly, and there will be a large amount of hidden blood loss after surgery. Reducing hidden blood loss can decrease complications and hospital stay.
OBJECTIVE: To evaluate the effect of prolonged use of tranexamic acid on hidden blood loss after proximal femoral nail antirotation implantation in senile intertrochanteric fractures.
METHODS: From January 2022 to May 2023, 62 elderly admitted patients with intertrochanteric fracture of femur were selected from Zigong Fourth People’s Hospital. All of them were treated with proximal femoral nail antirotation implantation after closed reduction on the traction bed. According to the use time of tranexamic acid, they were divided into two groups. In the control group (n=38), 1 g tranexamic acid was given intravenically 15-30 minutes before incision, and 1 g was added 3 hours later. Based on the control group, the trial group (n=24) was given 1 g tranexamic acid intravenously once for 12 hours on the first day after surgery. Blood routine examinations were performed before surgery, on the day after surgery, and on the first, third and fifth days after surgery. Hemoglobin and hematocrit were counted. The theoretical total blood loss was calculated by Cross equation, and the incidence of complications in the two groups was recorded.
RESULTS AND CONCLUSION: (1) Through statistical analysis, there was no significant difference in the amount of dominant blood loss between the two groups (P > 0.05). (2) The number of grams of hemoglobin decreased, total blood loss and hidden blood loss in the trial group during perioperative period were lower than those in the control group, and the differences were statistically significant (P < 0.05). (3) The hemoglobin values of the trial group on day 3 after surgery, and the hematocrit values on days 1 and 3 after surgery were higher than those of the control group, with statistical significance (P < 0.05). (4) The hemoglobin and platelet count showed a downward trend after surgery, and the hemoglobin value was the lowest value on day 3, and the platelet value was the lowest value on day 1 after surgery, and then began to rise in both groups. (5) There was no significant difference in postoperative complications between the two groups (P > 0.05). (6) The results show that prolonging use of tranatemic acid can effectively reduce the hidden blood loss in the treatment of femoral intertrochanteric fracture with proximal anti-rotation intramedullary nail, and does not increase the risk of complications.

Key words: tranexamic acid, intertrochanteric fracture of femur, proximal femoral nail antirotation, hidden blood loss, hemoglobin, platelet count