A single dose of tranexamic acid infusion is safe and effective to reduce total blood loss during proximal femoral nailing for intertrochanteric fractures: A prospective randomized study

Abstract

Background: Tranexamic acid (TXA) has been shown to reduce intraoperative bleeding and the need for post-operative allogenic blood transfusion requirement in surgery. In our randomized controlled study, we aimed to evaluate the effect of pre-operative 15 mg/kg intravenous TXA on total blood loss (TBL), hidden blood loss (HBL), and transfusion requirement in elderly patient group with intertrochanteric femoral fracture (ITFF) and treated with proximal femoral nailing (PFN).

Methods: Patients diagnosed with ITFFs (AO types 31-A1 and 31-A2) and treated using closed reduction and PFN was divided into two groups in our prospective randomized study. Group 1 (TXA group) was administered 15 mg/kg of TXA 15 min before the incision was made, after anesthesia was given, in the form of an IV infusion in 100 cc of saline. Group 2 (control group) was given only 100 cc of isotonic saline. The primary outcome of the study was TBL. The secondary outcomes were the number of transfusions, HBL, and the surgical (intraoperative) blood loss during the operative procedure and post-operative complications. The outcome values were compared between two groups.

Results: One hundred and two patients (51 patients in each group) were included in our study. There were no statistically significant differences between the two groups in terms of their demographic characteristics and their pre-operative hemoglobin and hematocrit values. The mean TBL was statistically lower in the TXA group than in the control group (684.6±370.1 ml vs. 971.2±505.3 ml, respectively; p=0.002). The amount of intraoperative blood loss was not significantly different between two groups (102.4±59.3 ml in the TXA group vs. 112.7±90.1 ml in the control group, p=0.67). However, the mean estimated HBL was significantly lower in the TXA group than in the control group (582.3±341.2 ml vs. 857.8±493.1 ml, respectively; p=0.002). The post-operative blood transfusion rate and transfusion unit were found to be significantly lower in the TXA group than in the control group (8% vs. 23.5%, respectively [p=0.033], and 6 U vs. 15 U, respectively [p=0.04]). Both medical and surgical post-operative complications were found to be similar for two groups.

Conclusion: Single dose of TXA significantly reduces TBL, HBL, and the need for blood transfusions following PFN in elderly patients with ITFFs, while it does not increase the risk of DVT or thromboembolic events.

Figure 1

Flow diagram of the study.