Tranexamic Acid in Pertrochanteric Femoral Fracture: Is it a Safe Drug or Not?

Abstract

Background: There is a high incidence of blood transfusion following hip fractures in elderly patients.

Aim: The aim of this study is to evaluate the effectiveness and complications of use of tranexamic acid in proximal femur nailing surgery.

Materials and methods: Our sample group consisted of 90 patients suffering from pertrochanteric fractures surgically treated with osteosynthesis with SupernailGT(LimaCorporate). The classification system AO/OTA was used to divide the fractures into 31A1 (n=45) and 31A2 (n=45). The patients were divided into two groups: 47 patients were administered 15 mg of tranexamic acid per kg (group A) and 43 patients were administered placebo (group B). Blood counts were monitored daily to evaluate the rate of anemia. As a safety criterion, we monitored the possible occurrence of vascular events, symptomatic or not, over the 8 weeks post-surgery. Markers predicting mortality and deep venous thrombosis (DVE) were also monitored (fibrinogen D-dimer).

Results: Blood loss occurring post-surgery can be influenced by numerous factors that are not linked to the use or non-use of tranexamic acid. While closely monitoring hemoglobin levels daily, we observed that 42% of the patients in group A required blood transfusion as opposed to 60% in group B. The results of the markers predicting mortality (alpha1-acid glycoprotein; albumin LDL) and those of DVE were not statistically significant between the two groups in this study (p>0.05).

Conclusion: Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss.

Keywords: elderly patients; hemoglobin monitoring; hypercoaguable blood; proximal femoral fracture; tranexamic acid.