Tranexamic acid reduces hidden blood loss in treatment of intertrochanteric fractures with proximal femoral nail anti-rotation

Abstract

Objective To assess the effect of preoperative administration of tranexamic acid (TXA) on the hidden blood loss in the surgery of intertrochanteric fractures with proximal femoral nail anti-rotation (PFNA). Methods Eighty patients with intertrochanteric fracture were treated with PFNA in our hospital from November 2015 to July 2016. They were 15 men and 65 women, with a mean age of 72.6 years. Of them, 39 were included into TXA group where TXA was administered preoperatively and 41 were assigned into the control group where no TXA was used preoperatively. Blood routine examinations were carried out on one day before operation, the first and third days after operation. The surgical blood loss, operative blood transfusion, 24-hour drainage after operation, and postoperative 3-day blood transfusion were recorded. The total and hidden blood losses were calculated according to the formula. The 2 groups were compared in terms of blood loss and complications. Results In TXA group, the total blood loss (1,632.3±849.2 mL), the hidden blood loss (1,270.9±623.3 mL) and the transfusion rate (28.2%) were significantly lower than those in the control group (2,014.8±924.7 mL, 1,549.1±624.9 mL and 56.1%) (P 0.05). Deep venous thrombosis occurred in 2 patients, limb swelling in one patient and wound dehiscence in one patient in TXA group while deep venous thrombosis occurred in one patient, limb swelling in 3 patients and wound dehiscence in none in the control group, showing no significant differences between the 2 groups (P>0.05). No infection was observed in either group. Conclusion Preoperative administration of TXA can reduce surgical hidden blood loss and transfusion rate as well but will not increase the risk of deep vein thrombosis in the surgery of intertrochanteric fractures with PFNA. Key words: Tranexamic acid; Hip fractures; Fracture fixation, intramedullary; Bone nails; Postoperative hemorrhage