Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study |
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| Institution: | 1. Institute of Orthopaedics, Max Hospital Mohali, Punjab, 160055, India;2. Senior Consultant, Institute of Orthopaedics, Max Hospital, Mohali Punjab, 160055, India;3. Orthopaedics, AIIMS Bhubaneswar, 751019, India;1. Department of Rehabilitation, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kouzidai, Nisi-Ku, Kobe, Hyogo 651-2273, Japan;2. Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city 950-3198, Japan;3. Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan;4. Department of Rehabilitation, Uonuma Kikan Hospital, 4132 Urasa, Minamionuma, Niigana 949-7302, Japan;1. Department of Orthopaedic Major Trauma Surgery, Orthopaedic post CCT Fellow, Queen Elizabeth University Hospital, 5/6 Gladstone Terrace, Glasgow, Edinburgh EH9 1LX, United Kingdom;2. Consultant Orthopaedic Surgeon, Queen Elizabeth University Hospital, Glasgow, United Kingdom;3. Queen Elizabeth University Hospital, Glasgow, United Kingdom;1. Department of Geriatric Rehabilitation, Meir Medical Center, Kfar Saba, Israel;2. Research Authority, Meir Medical Center, Kfar Saba, Israel;3. Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel;4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;1. State School of Public Health Candido Santiago, State Department of Health of Goiás, Goiânia, Goiás, Brazil;2. State School of Public Health Candido Santiago, State Department of Health of Goiás, Goiânia, Goiás, Brazil;3. State School of Public Health Candido Santiago, State Department of Health of Goiás, Goiânia, Goiás, Brazil;4. Specialist in urgency and emergency. State Emergency Hospital of Goiânia Dr. Valdemiro Cruz, State Department of Health of Goiás, Goiânia, Goiás;5. Doctor of Health Sciences. Superintendência de Estado de Saúde de Goiás, Secretaria de Estado da Saúde de Goiás, Goiânia, Goiás, Brazil;6. Doctor in nursing. Federal University of Goiás, Goiânia, Goiás, Brazil;1. Harvard Medical School, Boston, MA, USA;2. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;3. Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | IntroductionOpen reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial.Material and methodsSixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated.ResultsBoth groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups.ConclusionThere is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures. |
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