Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial

Jinlai Lei,Xing Wei,Pengfei Wang,Hai Huang,Shuang Han,Shiming Wen,Kun Zhang,Hu Wang,Yan Zhuang,Yuxuan Cong,Wei Wei,Yahui Fu,Shuguang Liu,Binfei Zhang

doi:10.1186/s13018-017-0625-9

Abstract

BackgroundHidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture.MethodsA total of 77 patients with intertrochanteric fracture were enrolled in this randomized controlled study. Patients received either 200 mL (1 g) of TXA (n = 37) or normal-saline (NS) (n = 40) i.v. before hip surgery using proximal femoral nail anti-rotation (PFNA). Hemoglobin and hematocrit levels were measured preoperatively and postoperatively at day 1 and 3. Visible and hidden blood loss volumes were calculated at postoperative day 3.ResultsOn postoperative day 3, the transfusion rate was significantly lower in the TXA group compared to the NS group, although mean hemoglobin and hematocrit levels were not significantly different between the two groups. However, the estimated hidden blood loss volume (210.09 ± 202.14 mL vs. 359.35 ± 290.12 mL; P < 0.05) and total blood loss volume (279.35 ± 209.11 mL vs. 417.89 ± 289.56 mL; P < 0.05) were significantly less in the TXA group compared to the NS group, respectively.ConclusionTXA significantly reduced postoperative hidden blood loss in patients with intertrochanteric fracture who underwent PFNA.(Registration number: ChiCTR-INR-16008134).

Highlights

Hidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture
Inclusion criteria were (1) patients with a definite history of trauma, fall or traffic accident; (2) patients suffering from hip pain, tenderness, dysfunction, local swelling, and vertical percussion pain in the area of the greater trochanter, with limited function in the injured limb; (3) patients with a confirmed diagnosis of intertrochanteric fracture and fracture classified according to AO type on X-ray or computed tomography (CT) [24]; and (4) patients eligible for intertrochanteric fracture surgery using the proximal femoral nail anti-rotation (PFNA) system (TianJin ZhengTian, XiaMen Double), as determined by the senior orthopedic surgeons at our institution
Between December 2015 and July 2016, 215 patients with intertrochanteric fractures were admitted to our institution through the emergency department

Summary

Introduction

Hidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture. Types of intertrochanteric fracture [4] and treatment [5] affect functional outcomes and mortality in patients with hip fracture. Perioperative hemoglobin and hematocrit levels have implications for outcomes, as patients with hip fracture are usually frail and elderly and prone to anemia and hypovolaemia [7,8,9]. One study showed that overall blood loss was 1473 mL greater than that observed intraoperatively in patients undergoing hip surgery [6], and another study

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