Tranexamic Acid Effectiveness on the Amount of Bleeding during Surgery and Surgeon’s Satisfaction in Intertrochanteric Fracture Fixation:A Randomized Clinical Trial

  • Morteza Saeb Department of Orthopedics, Faculty of medicine, Kermanshah University of Medical Sciences, Taleqani Hospital
  • Ali Mousapour Department of Orthopedics, Faculty of medicine , Kermanshah University of Medical Sciences, Taleqani Hospital
  • Alireza Shafiee Mail Department of Orthopedics, Kermanshah University of Medical Sciences, Taleqani Hospital
  • Seyyd Saeed Khabiri Department of Orthopedics, Faculty of medicine, Kermanshah University of Medical Sciences, Taleqani Hospital
  • Roya Safari-Faramani Department of Epidemiology, Faculty of medicine, Kermanshah University of Medical Sciences
  • Ali Gholami Department of Anesthesiology, Faculty of medicine, Kermanshah University of Medical Sciences
  • Keykhosro Mardanpour Faculty of medicine,Kermanshah University of Medical Sciences,Taleqani Hospital
  • Monireh Yaghoubi Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
  • Sepehr Rahimipour Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
  • Adel Hojabrian Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
Keywords:
Tranexamic Acid, IntertrochantericFracture, Hemorrhage Volume during Surgery, Surgeon Satisfaction

Abstract

Introduction:

The purpose of this double-blind randomized clinical trial study was the evaluation of intravenous tranexamic acid on hemorrhage volume during Surgery and surgeon's satisfaction in intertrochanteric fracture surgery.

 Material and Methods:

A total of 62 intertrochanteric fractures (AO class 1 to 3) were randomly divided into two groups of 31. In the control group patients (69.2± 6.1 years old) treated with placebo and the intervention group receiving1gr tranexamic acid (69.7± 6.4) have exposed under the surgical operation by lateral approach and proximal femur’s plates., the amount of gauze and post operative blood losses measured with the amount of blood in the drain 48 hours after surgery. Also the hemoglobin levels compared before and after surgery. In the end, Surgeon satisfaction was measured by Likert scale.

Results:

The amount of intraoperative bleeding in suctiondid not differ statistically between the arms (P-value = 0.465).Furthermore, the mean of gauze number in the intervention group was significantly lower than the control group (P-value <0.05). although  the mean amount of blood in the drain 48 hours after surgery in the control group was higher than the intervention group B, but it was not statistically significant (P-value = 0.05). The mean of hemoglobin in the control group was significantly lower than group B (P-value <0.05).the proportion of patients in need of transfusion in the control group was significantly higher than the intervention group (P-value <0.005). Mean of satisfaction in the intervention group was significantly higher than the other arm (P-value <0.05).

Conclusion:

The evaluation of intravenous tranexamic acid duringintertrochanteric fracture surgery can reduce hemorrhage volume during Surgery, reduce the need ofblood products’ transfusionand finally improve surgeon satisfaction.

Author Biographies

Morteza Saeb, Department of Orthopedics, Faculty of medicine, Kermanshah University of Medical Sciences, Taleqani Hospital

Associate Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Ali Mousapour, Department of Orthopedics, Faculty of medicine , Kermanshah University of Medical Sciences, Taleqani Hospital
Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermans Sciences, Iran
Alireza Shafiee, Department of Orthopedics, Kermanshah University of Medical Sciences, Taleqani Hospital
Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Seyyd Saeed Khabiri, Department of Orthopedics, Faculty of medicine, Kermanshah University of Medical Sciences, Taleqani Hospital
Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Roya Safari-Faramani, Department of Epidemiology, Faculty of medicine, Kermanshah University of Medical Sciences
  Assistant Professor, Department of Epidemiology, Research Center for Environmental Determinants of Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
Ali Gholami, Department of Anesthesiology, Faculty of medicine, Kermanshah University of Medical Sciences
Assistant Professor, Department of Anesthesiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Keykhosro Mardanpour, Faculty of medicine,Kermanshah University of Medical Sciences,Taleqani Hospital
Associate Professor, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Monireh Yaghoubi, Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Sepehr Rahimipour, Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
Adel Hojabrian, Department of Orthopedics, Kermanshah University of Medical Sciences,Taleqani Hospital
Senior Resident, Department of Orthopedic Surgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

References

1. Rockwood CA, Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green's fractures in adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

2. Wanderer JP, Rathmell JP. Searching for quality: Hip Fractures and type of anesthesia. Anesthesiology. 2018;128(3):A1. doi: 10.1097/ALN.0000000000002115.

3. Craven RM. Managing anaesthetic provision for global disasters. Br J Anaesth. 2017;119(suppl_1):i126-i134. doi: 10.1093/bja/aex353. [PubMed: 29161394].

4. Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M, Mazumdar M. Anesthetic care for orthopedic patients: Is there a potential for differences in care? Anesthesiology. 2016;124(3):608-23. doi: 10.1097/ALN.0000000000001004. [PubMed: 26771909].

5. Jones KE, Butler EK, Barrack T, Ledonio CT, Forte ML, Cohn CS, et al. Tranexamic acid reduced the percent of total blood volume lost during adolescent idiopathic scoliosis surgery. Int J Spine Surg. 2017;11(4):27. doi: 10.14444/4027. [PubMed: 29372131]. [PubMed Central: PMC5779269].

6. Franchini M, Mengoli C, Marietta M, Marano G, Vaglio S, Pupella S, et al. Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: A meta-analysis of randomised controlled trials. Blood Transfus. 2018;16(1):36-43. doi: 10.2450/2017.0219-17. [PubMed: 29337665]. [PubMed Central: PMC5770313].

7. Koehler D, Marsh JL, Karam M, Fruehling C, Willey M. Efficacy of surgical-site, multimodal drug injection following operative management of femoral fractures: A randomized controlled trial. J Bone Joint Surg Am. 2017;99(6):512-9. doi: 10.2106/JBJS.16.00733. [PubMed: 28291185].

8. Casati V, Sandrelli L, Speziali G, Calori G, Grasso MA, Spagnolo S. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomized, double-blind, placebo-controlled study. J Thorac Cardiovasc Surg. 2002;123(6):1084-91. doi: 10.1067/mtc.2002.120717. [PubMed: 12063454].
9. Kerr AR. Anaesthesia with profound hypotension for middle ear surgery. Br J Anaesth. 1977;49(5):447-52. doi: 10.1093/bja/49.5.447. [PubMed: 861111].

10. Subramanyam KN, Khanchandani P, Tulajaprasad PV, Jaipuria J, Mundargi AV. Efficacy and safety of intra-articular versus intravenous tranexamic acid in reducing perioperative blood loss in total knee arthroplasty: A prospective randomized double-blind equivalence trial. Bone Joint J. 2018;100-B(2):152-60. doi: 10.1302/0301-620X.100B2.BJJ-2017-0907.R1. [PubMed: 29437056].

11. Bullmann V, Granitzka M. Blood management in complex reconstructive spine surgery in ASD patients: Do effective measures to reduce bleeding exist?. Orthopade. 2018;47(4): 296-300. doi: 10.1007/s00132-018-3535-6. [PubMed: 29435595].

12. Zhang S, Xiao C, Pei F. Research progress on tranexamic acid in traumatic orthopedic surgery. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019;33(11):1457-61. doi: 10.7507/1002-1892.201902030. [PubMed: 31650766].

13. Zeng Y, Si H, Li C, Wu Y, Shen B. Effect of knee flexion position and combined application of tranexamic acid on blood loss following primary total knee arthroplasty: A prospective randomized controlled trial. Int Orthop. 2018;42(3):529-35. doi: 10.1007/s00264-018-3808-z. [PubMed: 29396806].

14. Zhu J, Zhu Y, Lei P, Zeng M, Su W, Hu Y. Efficacy and safety of tranexamic acid in total hip replacement: A PRISMA-

compliant meta-analysis of 25 randomized controlled trials.

Medicine (Baltimore). 2017;96(52):e9552. doi:

10.1097/MD.0000000000009552. [PubMed: 29384974].

[PubMed Central: PMC6393088].

15. Tian S, Shen Z, Liu Y, Zhang Y, Peng A. The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA. Injury. 2018;49(3):680-4. doi: 10.1016/j.injury.2018.01.026. [PubMed: 29426608].

16. Zhou XD, Zhang Y, Jiang LF, Zhang JJ, Zhou D, Wu LD, et al. Efficacy and Safety of Tranexamic Acid in Intertrochanteric Fractures: A Single-Blind Randomized Controlled Trial. Orthop Surg. 2019;11(4):635-42. doi: 10.1111/os.12511. [PubMed: 31419080]. [PubMed: PMC6712408].

17. Jiang W, Shang L. Tranexamic acid can reduce blood loss in patients undergoing intertrochanteric fracture surgery: A meta-analysis. Medicine (Baltimore). 2019;98(11):e14564. doi:
10.1097/MD.0000000000014564.[PubMed:30882622].
[PubMed Central: PMC6426473].

18. Chen F, Jiang Z, Li M, Zhu X. Efficacy and safety of perioperative tranexamic acid in elderly patients undergoing trochanteric fracture surgery: A randomised controlled trial. Hong Kong Med J. 2019;25(2):120-6. doi: 10.12809/hkmj187570. [PubMed: 30919809].

19. Krebs NM, VanWagner MJ, Marchewka T, Faraj U, Vitale CR. Tranexamic Acid in the Treatment of Hip Fractures: A Clinical Review. Spartan Medical Research Journal. 2019;3(3):7026.
Published
2020-07-20
How to Cite
1.
Saeb M, Mousapour A, Shafiee A, Khabiri SS, Safari-Faramani R, Gholami A, Mardanpour K, Yaghoubi M, Rahimipour S, Hojabrian A. Tranexamic Acid Effectiveness on the Amount of Bleeding during Surgery and Surgeon’s Satisfaction in Intertrochanteric Fracture Fixation:A Randomized Clinical Trial. J Orthop Spine Trauma. 5(1):17-20.
Section
Research Articles