Specialist Trainee in Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Little France Cres, Edinburgh, Edinburgh, EH164SA, Scotland, UK.
University of Edinburgh, Edinburgh, Scotland, UK.
World J Surg. 2023 Apr;47(4):912-921. doi: 10.1007/s00268-022-06886-2. Epub 2023 Feb 1.
This study aims to determine whether intraoperative intravenous (IV) tranexamic acid (TXA) affects blood loss following the surgical management of femoral fragility fractures (FFF).
This was a single centre (university teaching hospital) non-randomised case-control study. There were 361 consecutive patients with FFF admitted over a 4-month period were included (mean age 81.4yrs; mean BMI 23.5; 73.7% female). Patient demographics, comorbidities, preoperative anticoagulation use, surgical management, intravenous TXA use, perioperative haemoglobin (Hb) and haematocrit, and requirement for blood transfusion were recorded. The primary outcome was postoperative blood transfusion requirement. Secondary outcomes included postoperative day one calculated blood loss (CBL) (using the Nadler and Gross formulae) and fall in Hb (percentage) from preoperative levels; and the incidence of thrombotic events and mortality up to 30 days.
Groups were well matched in terms of patient demographics, comorbidities, preoperative anticoagulation use, injury types and surgical management. Intravenous TXA 1 g given at the beginning of surgery at the discretion of the operating team: 178 (49%) received TXA and 183 (51%) did not. The requirement for postoperative blood transfusion was significantly less in the TXA group: 15/178 (8.4%) compared to 58/183 (31.7%) (p < 0.001; Chi square). TXA significantly reduced both the percentage fall in Hb (mean difference 4.3%, p < 0.001) and the CBL (mean difference -222 ml, p < 0.001). There was no difference in VTE (2 vs 1, p = 0.620) or other thrombotic events (2 vs 0, p = 0.244) between groups.
1 g of intraoperative intravenous TXA during the surgical management of FFF was associated with reduced rate of transfusion, CBL and the percentage drop in HB. The use of TXA in this study was not randomised, so there could be un-quantifiable bias in the patient selection.
本研究旨在确定术中静脉注射（IV）氨甲环酸（TXA）是否会影响股骨脆性骨折（FFF）手术治疗后的失血情况。
这是一项单中心（大学教学医院）非随机病例对照研究。在 4 个月的时间内，共收治了 361 例连续的 FFF 患者（平均年龄 81.4 岁；平均 BMI 23.5；73.7%为女性）。记录患者的人口统计学、合并症、术前抗凝使用、手术管理、静脉 TXA 使用、围手术期血红蛋白（Hb）和血细胞比容以及输血需求。主要结局是术后输血需求。次要结局包括术后第 1 天计算的失血量（CBL）（使用 Nadler 和 Gross 公式）和从术前水平下降的 Hb（百分比）；以及 30 天内血栓事件和死亡率的发生率。
两组患者在人口统计学、合并症、术前抗凝使用、损伤类型和手术管理方面匹配良好。术中 TXA 1g 根据手术团队的判断在手术开始时给予：178 例（49%）接受 TXA，183 例（51%）未接受 TXA。TXA 组术后输血需求明显减少：15/178（8.4%）比 58/183（31.7%）（p<0.001；卡方）。TXA 显著降低了 Hb 百分比下降（平均差异 4.3%，p<0.001）和 CBL（平均差异-222ml，p<0.001）。两组之间在 VTE（2 比 1，p=0.620）或其他血栓事件（2 比 0，p=0.244）方面没有差异。
在 FFF 的手术治疗中，术中静脉注射 1g TXA 与输血、CBL 和 HB 百分比下降的发生率降低相关。本研究中 TXA 的使用不是随机的，因此在患者选择中可能存在无法量化的偏倚。
