Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center ran
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RESEARCH ARTICLE
Open Access
Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial Jinlai Lei, Binfei Zhang, Yuxuan Cong, Yan Zhuang*, Xing Wei, Yahui Fu, Wei Wei, Pengfei Wang, Shiming Wen, Hai Huang, Hu Wang, Shuang Han, Shuguang Liu and Kun Zhang*
Abstract Background: 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. Methods: A 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. Results: On 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. Conclusion: TXA significantly reduced postoperative hidden blood loss in patients with intertrochanteric fracture who underwent PFNA. (Registration number: ChiCTR-INR-16008134). Keywords: Tranexamic acid, Hidden blood loss, Intertrochanteric femora, Fracture, PFNA, Randomized controlled trial
Background Globally, hip fracture is a frequent cause of morbidity and mortality, especially in elderly people [1, 2]. Intertrochanteric fracture is one of the three major types of hip fracture, comprising approximately half of all hip fractures. Intertrochanteric fracture usually occurs in patients with a history of falls or bone disease, and results from a low-energy mechanism such as a fall from standing [3]. Patients typically present with pain and difficulty walking. * Correspondence: [email protected]; [email protected] Department of Orthopaedic Trauma, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, No 555, Youyi East Road, Xi’an, Shaanxi Province, China
Types of intertrochanteric fracture [4] and treatment [5] affect functional outcomes and mortality in patients with hip fracture. Patients with intertrochanteric fractures incur more blood loss than those with femoral neck fractures and have a higher rate of transfusion [6]. In addition, perioperative hemoglobin and hematocrit levels have implications for outcomes, as patients with hip fracture are usually frail and elderly and particularly prone to anemia and hypovolaemia [7–9].
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