PFNA 治疗老年股骨粗隆间骨折围手术期血液管理中创伤后抗纤溶的作用：一项随机对照试验。

The role of post-traumatic antifibrinolysis in the perioperative blood management of elderly patients with intertrochanteric fractures treated with PFNA: A randomised controlled trial.

机构信息

Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Orthopaedic Research Laboratory of Chongqing Medical University, 1 Youyi Rd, Chongqing 400016, PR China.

出版信息

Injury. 2024 Dec;55(12):111877. doi: 10.1016/j.injury.2024.111877. Epub 2024 Oct 24.

DOI:10.1016/j.injury.2024.111877

PMID:39504735

Abstract

BACKGROUND

This study aimed to evaluate the efficacy and safety of posttraumatic antifibrinolytic therapy with repeated doses of intravenous tranexamic acid (IV-TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric femur fracture (IFF) patients.

METHOD

112 elderly IFF patients who were admitted to our department from March 2020 to May 2021 were randomized to receive 100 ml of normal saline (Control group) or 1.5 g of TXA (TXA group) intravenously q12 h from postadmission day 1 (PAD1) to PAD3. Hemoglobin (Hb), hematocrit (Hct), fibrinogen degradation product (FDP), D-dimer (D-D), and coagulation parameters were recorded from PAD1 to postoperative day 3 (POD3). HBL was calculated using the gross formula and recorded as the primary outcome.

RESULT

The patients in TXA group had lower preoperative hidden blood loss(HBL), decline of hemoglobin(ΔHb), FDP (on PAD3), and D-D (on PAD3) compared with control group, while no difference was found in postoperative HBL, postoperative ΔHb and allogeneic blood transfusion (ABT) rate. In subgroup analyses, it was observed that patients who received the intervention within 24 h of injury and between 24 and 72 h of injury exhibited significantly lower preoperative HBL and ΔHb in the TXA group compared with the control group. Furthermore, the reduction in HBL and ΔHb was more pronounced in the former group. While for patients who received the intervention beyond 72 h after injury, no significant differences were observed in preoperative HBL and ΔHb between the two groups. Similarly, no significant differences were noted in postoperative HBL and ΔHb between the TXA and control groups across all subgroups. Additionally, no significant differences were identified in the incidence of venous thromboembolism (VTE) and mortality within one year between the two groups.

CONCLUSION

Post-traumatic antifibrinolytic therapy with repeated doses of intravenous TXA is effective and safe in reducing perioperative HBL for elderly IFF patients, especially for patients injured within 24 h.

摘要

背景

本研究旨在评估反复静脉注射氨甲环酸（IV-TXA）的创伤后抗纤维蛋白溶解疗法在减少老年股骨转子间骨折（IFF）患者围手术期隐性失血（HBL）方面的疗效和安全性。

方法

2020 年 3 月至 2021 年 5 月，我科收治的 112 例老年 IFF 患者随机分为对照组（接受 100ml 生理盐水）和 TXA 组（接受 1.5g TXA，iv，q12h，从入院第 1 天至第 3 天）。从入院第 1 天（PAD1）至术后第 3 天（POD3）记录血红蛋白（Hb）、红细胞压积（Hct）、纤维蛋白降解产物（FDP）、D-二聚体（D-D）和凝血参数。根据总量公式计算隐性失血量（HBL），作为主要结局。

结果

与对照组相比，TXA 组患者术前隐性失血（HBL）、血红蛋白下降（ΔHb）、FDP（PAD3）和 D-D（PAD3）较低，而术后 HBL、术后ΔHb和异体输血（ABT）率无差异。亚组分析显示，受伤后 24 小时内和 24-72 小时内接受干预的患者，TXA 组术前 HBL 和ΔHb 明显低于对照组。此外，前者组 HBL 和ΔHb 的降低更为明显。而对于受伤后 72 小时后接受干预的患者，两组术前 HBL 和ΔHb 无显著差异。同样，两组术后 HBL 和ΔHb 在所有亚组中均无显著差异。此外，两组患者静脉血栓栓塞症（VTE）和一年内死亡率无显著差异。