Sahni Girish, Sood Monika, Girdhar Deepak, Sahni Priya, Jain Ayush Kumar, Kumar Sanjeev
Department Of Orthopaedics, Government Medical College and Hospital, Patiala, Punjab, India.
Department Of Microbiology, Government Medical College and Hospital, Patiala, Punjab, India.
Int J Appl Basic Med Res. 2021 Jul-Sep;11(3):139-142. doi: 10.4103/ijabmr.IJABMR_638_20. Epub 2021 Jul 19.
Hip fractures in orthopedic trauma cases are increasing. Majority of such patients undergoing surgery require blood transfusion of one or more units. Intravenous (I. V.) Tranexamic acid (TXA) may decrease loss of blood, decrease need of blood transfusion, and improve postoperative hemoglobin (Hb) along with lesser adverse effects. Risk of thromboembolic phenomena remains a concern. A study was done to analyze the role of I. V. TXA in hip fracture surgeries in trauma cases.
Sixty patients were included in the study; in two groups (37 males and 23 females), Group A in which two doses of I. V. TXA 15 mg/kg were given and Group B in which two doses of I. V. placebo were given.
Total number of randomized hip arthroplasty cases was 22 (11 in Group A and 11 in Group B) whereas randomized osteosynthesis cases were 38 (19 in Group A and 19 in Group B). Mean preoperative Hb value in Group A was 10.8 gm% and in Group B was 10.7 gm% ( > 0.005. Mean postoperative Hb value in Group A was Hb 9.8 gm% and in Group B 9.5 gm% (difference of 3.061%). Mean duration of surgery in Group A was 64.2 min and in Group B was 66.3 min. Mean total blood loss (intraoperative and postoperative) in Group A was 384.6 ml and in Group B was 448.7 ml (14.29% less in Group A). A total of 14 patients in Group A (17 red blood cells [RBCs] units) and 17 patients (21 RBC units) in Group B required RBC transfusion. No major vascular event, severe bacterial infections, symptomatic deep vein thrombosis, pulmonary embolism, limb ischemia, acute coronary syndrome, or immediate postoperative mortality was noted in either group.
I. V. TXA has the potential to decrease risk of blood transfusion, decrease total blood loss, and to maintain a higher postoperative Hb value with no significant adverse reactions. As the number of cases of hip fractures continues to increase along with increase in age, so the use of TXA in such cases may improve clinical outcomes, lessen number of inpatient days and hence decrease overall cost.
骨科创伤病例中的髋部骨折数量正在增加。大多数接受手术的此类患者需要输注一个或多个单位的血液。静脉注射氨甲环酸（TXA）可能会减少失血、减少输血需求，并提高术后血红蛋白（Hb）水平，同时不良反应较少。血栓栓塞现象的风险仍然是一个问题。开展了一项研究以分析静脉注射TXA在创伤病例髋部骨折手术中的作用。
本研究纳入60例患者；分为两组（37例男性和23例女性），A组给予两剂静脉注射TXA 15mg/kg，B组给予两剂静脉注射安慰剂。
随机分组的髋关节置换病例总数为22例（A组11例，B组11例），而随机分组的骨固定病例为38例（A组19例，B组19例）。A组术前平均Hb值为10.8g%，B组为10.7g%（>0.005）。A组术后平均Hb值为9.8g%，B组为9.5g%（差异为3.061%）。A组平均手术时长为64.2分钟，B组为66.3分钟。A组平均总失血量（术中及术后）为384.6毫升，B组为448.7毫升（A组少14.29%）。A组共有14例患者（17个红细胞[RBC]单位）和B组17例患者（21个RBC单位）需要输注RBC。两组均未出现重大血管事件、严重细菌感染、有症状的深静脉血栓形成、肺栓塞、肢体缺血、急性冠状动脉综合征或术后即刻死亡。
静脉注射TXA有降低输血风险、减少总失血量并维持较高术后Hb值的潜力，且无明显不良反应。随着髋部骨折病例数量随着年龄增长持续增加，因此在此类病例中使用TXA可能会改善临床结局、减少住院天数并因此降低总体费用。
