Early Posttraumatic Antifibrinolysis Reduces Perioperative Hidden Blood Loss in Elderly Patients with an Intertrochanteric Fracture: A Randomized Controlled Trial

作者全名："Luo, Gang; Chen, Zhiguo; Liu, Jiacheng; Ni, Weidong; Huang, Wei"

作者地址："[Luo, Gang; Chen, Zhiguo; Liu, Jiacheng; Ni, Weidong; Huang, Wei] Chongqing Med Univ, Orthoped Lab, Dept Orthoped, Affiliated Hosp 1, Chongqing 400016, Peoples R China"

通信作者："Huang, W (通讯作者)，Chongqing Med Univ, Orthoped Lab, Dept Orthoped, Affiliated Hosp 1, Chongqing 400016, Peoples R China."

来源：JOURNAL OF CLINICAL MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001045550100001

JCR分区：Q1

影响因子：3

年份：2023

卷号：12

期号：15

开始页：　

结束页：　

文献类型：Article

关键词：posttraumatic antifibrinolysis; tranexamic acid; intertrochanteric fracture; hidden blood loss

摘要："Background: This study aimed to determine the efficacy and safety of posttraumatic antifibrinolysis with multidose tranexamic acid (TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric fracture patients. Method: Ninety-six elderly intertrochanteric fracture patients admitted to our department from June 2021 to September 2022 were randomized into two groups. The control group (Group A) received 100 mL of normal saline, while the experimental group (Group B) received 1.5 g of TXA intravenously q12 h from postadmission Day 1 (PAD1) to the day before surgery, and both groups received 1.5 g of TXA q12 h from postoperative Day 1 (POD1) to POD3. Haemoglobin (Hb), haematocrit (Hct), coagulation parameters, fibrinogen degradation product (FDP), and D-dimer (D-D) were recorded from PAD1 to POD3. HBL was calculated using the gross formula and recorded as the primary outcome. Result: In all-over analyses, the patients in Group B had lower perioperative HBL (on PAD3, POD1, and POD3), preoperative HBL (HBLpre), decline of haemoglobin (& UDelta;Hb-on PAD3), allogeneic blood transfusion (ABT) rate, FDP (on PAD3), and D-D (on PAD3) compared with Group A. No significant differences were exhibited in postoperative HBL (HBLpost) between the 2 groups. In subgroup analyses, for patients who received intervention within 24 h, the result is consistent with the whole. For patients who received intervention over 72 h of injury, there were no significant differences in perioperative HBL, & UDelta;Hb, ABT rate, FDP, and D-D between the 2 groups. There were no significant differences in APTT, PT, the rate of venous thromboembolism, wound complications, or 90-day mortality between the 2 groups. Conclusion: For elderly intertrochanteric fracture patients, early posttraumatic antifibrinolysis with multidose TXA is effective in reducing perioperative HBL, which mainly manifests as the reduction of preoperative HBL, especially for patients injured within 24 h. Application of TXA beyond 72 h of injury was ineffective."

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