Effect of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation for femoral intertrochanteric fracture

doi:10.3969/j.issn.2095-4344.3859

Abstract

Abstract: BACKGROUND: There is still no uniform standard for the optimal use of tranexamic acid in proximal femoral nail antirotation for femoral intertrochanteric fracture.
OBJECTIVE: To investigate the effect and safety of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation in patients with femoral intertrochanteric fracture.
METHODS: Totally 100 patients with intertrochanteric fracture treated by proximal femoral nail antirotation in the Affiliated Hospital of Xuzhou Medical University from September 2017 to June 2020 were randomly divided into three groups. In the single-dose group, 33 patients were given tranexamic acid 1.0 g intravenously half an hour before operation. In the repeated-dose group, 35 patients were given the same medicine as the single-dose group before operation, and repeated intravenous drip of tranexamic acid 1.0 g at 3 and 6 hours after operation. In the control group, 32 patients were given an equal volume of physiological saline half an hour before operation. The baseline data, operation time, intraoperative blood loss, postoperative drainage volume, perioperative hemoglobin, hematocrit, C-reactive protein and interleukin-6 were collected from the three groups. Color Doppler ultrasound examination of lower extremity deep vein was conducted; and the total blood loss, hidden blood loss and thrombosis rate were calculated before and 7 days after operation.
RESULTS AND CONCLUSION: (1) Total blood loss was significantly lower in the repeated-dose group (499.20±189.80) mL than that in the single-dose group (722.33±241.76) mL and control group (859.41±165.03) mL (P < 0.05). The hidden blood loss was significantly lower in the repeated-dose group (359.03± 208.57) mL than that in the single-dose group (544.73±290.69) mL and control group (719.22±204.08) mL (P < 0.05). (2) Compared with C-reactive protein and interleukin-6 in three groups after operation, the inflammatory indexes in repeated-dose group were the lowest and those in the control group were the highest (P < 0.05). (3) There was no pulmonary embolism in the three groups, and the lower extremity thrombosis was asymptomatic intermuscular venous thrombosis. There were two cases (2/32) in the control group, four cases (4/33) in single-dose group, and three cases (3/35) in repeated-dose group. The difference was not statistically significant (P < 0.05). (4) It is indicated that repeated use of tranexamic acid in the perioperative period of proximal femoral nail antirotation can further reduce the hidden blood loss, and reduce the inflammatory reaction without increasing the risk of thrombosis.

Key words: femoral intertrochanteric fracture, proximal femoral nail antirotation, internal fixation, tranexamic acid, blood loss, antiinflammatory

CLC Number:

Wang Hao, Wang Yitao, Lü Zexiang, Li Tengfei, Wang Shaolong, Wang Yehua. Effect of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation for femoral intertrochanteric fracture[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3319-3323.

Figures/Tables 7

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