Department of Orthopedic Surgery, Suzhou Yongding Hospital, Suzhou, Jiangsu, China (mainland).
Med Sci Monit. 2024 Jun 14;30:e944063. doi: 10.12659/MSM.944063.
BACKGROUND This prospective study from a single center aimed to compare the perioperative blood loss (PBL) in 79 patients with intertrochanteric fractures (IF) treated with intramedullary nailing (IMN) using 3 regimens of combined tranexamic acid (TXA) and low molecular weight heparin (LMWH), proposing a novel therapy of 4-dose TXA. MATERIAL AND METHODS We recruited 79 patients and randomly divided them into 3 groups. The 4-dose TXA group (22 patients) received 1.0 g intravenous TXA 30 min before surgery and 1.0 g at intervals of 3, 6, and 9 h before surgery. The 1-dose TXA group (25 patients) received 1.0 g intravenous TXA 30 min before surgery, while the control group (32 patients) did not receive TXA. LMWH was applied 12 h after surgery in each group. The primary metrics evaluated included hidden blood loss (HBL), total blood loss (TBL), and the number and incidence rate of deep vein thrombosis (DVT). RESULTS Analysis of the HBL revealed that the 4-dose TXA group had the lowest average (583.13±318.08 ml), followed by the 1-dose TXA group (902.94±509.99 ml), and the control group showed the highest (1154.39±452.06 ml) (P<0.05). A similar result was observed for TBL (4-dose group: 640.86±337.22 ml, 1-dose group: 971.74±511.14 ml, control group: 1226.27±458.22 ml, P<0.05). Regarding DVT, the 4-dose TXA group had 5 cases (incidence rate 22.73%), the 1-dose TXA group had 6 cases (incidence rate 24.00%), and the control group had 8 cases (incidence rate 25.00%), with no significant difference among groups (P>0.05). CONCLUSIONS Treatment using 4-dose TXA and LMWH can effectively reduce PBL without increasing the DVT risk in IF patients with IMN.
本前瞻性研究来自一家单中心，旨在比较使用三种氨甲环酸（TXA）和低分子肝素（LMWH）联合方案治疗 79 例股骨转子间骨折（IF）患者的围手术期出血量（PBL），并提出一种新的 4 剂量 TXA 治疗方案。
我们招募了 79 例患者，并将其随机分为 3 组。4 剂量 TXA 组（22 例）于术前 30 分钟静脉给予 1.0 g TXA，术前 3、6 和 9 小时间隔给予 1.0 g。1 剂量 TXA 组（25 例）于术前 30 分钟静脉给予 1.0 g TXA，而对照组（32 例）未给予 TXA。每组均于术后 12 小时给予 LMWH。主要评估指标包括隐性失血（HBL）、总失血量（TBL）以及深静脉血栓形成（DVT）的数量和发生率。
HBL 分析显示，4 剂量 TXA 组平均出血量最低（583.13±318.08 ml），其次是 1 剂量 TXA 组（902.94±509.99 ml），对照组最高（1154.39±452.06 ml）（P<0.05）。TBL 也有类似的结果（4 剂量组：640.86±337.22 ml，1 剂量组：971.74±511.14 ml，对照组：1226.27±458.22 ml，P<0.05）。关于 DVT，4 剂量 TXA 组有 5 例（发生率 22.73%），1 剂量 TXA 组有 6 例（发生率 24.00%），对照组有 8 例（发生率 25.00%），组间无显著差异（P>0.05）。
在接受股骨转子间骨折髓内钉治疗的患者中，使用 4 剂量 TXA 和 LMWH 治疗可有效减少 PBL，而不会增加 DVT 风险。
