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. 2020 Nov 12;21(1):739.
doi: 10.1186/s12891-020-03772-7.

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Zhimeng Wang  1   2 , Yao Lu  1   3   4 , Qian Wang  1 , Leilei Song  5 , Teng Ma  1 , Cheng Ren  1 , Zhong Li  1 , Jiarui Yang  1 , Kun Zhang  6 , Bing Zhang  7
Affiliations

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Zhimeng Wang et al. BMC Musculoskelet Disord. .

Abstract

Background: Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.

Material and methods: This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.

Results: Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P<0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P<0.05), 2.8 vs 3.3 (POD4, P<0.05), and 2.1 vs. 2.6 (PO6W, P<0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.

Conclusion: To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.

Trial registration: The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR-TRC-1800017754 , retrospectively registered from 2018 to 01-01).

Keywords: Hyperfibrinolysis; Tibial plateau fracture; Tranexamic acid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of TBL in the three groups. *** indicated P < 0.001 (i.v. group or topical group vs control group); ### indicated P < 0.001 (i.v. group vs control group). Intergroup comparisons were performed using ANOVA
Fig. 2
Fig. 2
Comparison of HBL in the three groups. *** indicated P < 0.001 (i.v. group or topical group vs control group); there was no difference between the i.v. group and topical group. Intergroup comparisons were performed using ANOVA
Fig. 3
Fig. 3
Comparison of VAS pain in the three groups. * indicated P < 0.05 (i.v. group or topical group vs control group); ** indicated P < 0.01 (i.v. group or topical group vs control group); *** indicated P < 0.001 (i.v. group or topical group vs control group); There was no difference between the i.v. group and topical group. Intergroup comparisons were performed using ANOVA. Abbreviations: two days after surgery, POD2; four days after surgery, POD4; six weeks after surgery, PO6W; twelve weeks after surgery, PO12W
Fig. 4
Fig. 4
Comparison of knee function between the three groups. There was no difference among the groups at the above time points
Fig. 5
Fig. 5
Comparison of PCS and MCS in the three groups. There was no difference among the groups at the above time points. Abbreviation: six weeks after surgery, PO6W; 12 weeks after surgery, PO12W
See this image and copyright information in PMC

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