Evaluation of efficacy and safety of perioperative multiple intravenous tranexamic acid administration in complex acetabular fractures_West China Medical Journal

Authors：

YU You , ZOU Chang , TAN Peng , Guy Romeo Kenmegne , YIN Yijie , HUANG Shenbo , HE Shuai ,  FANG Yue

1. Department of Orthopedic Surgery / Trauma Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FANG Yue, Email: fangyue1968@163.com

Keywords：

Complex acetabular fracture; perioperative; multiple intravenous; tranexamic acid; efficacy and safety

DOI：

10.7507/1002-0179.202311281

Video：

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Objective To explore the efficacy and safety of perioperative multiple intravenous tranexamic acid (TXA) administration in complex acetabular fracture. Methods The patients with complex acetabular fractures admitted to the Department of Orthopedic Surgery / Trauma Center of West China Hospital, Sichuan University between September 2021 and December 2022 for a planned surgery were selected. The patients were randomly divided into a control group and an experimental group according to TXA administration protocol. The general information, total blood loss, 48 h postoperative blood drainage, recessive blood loss, fibrinolysis index, transfusion rate, and incidence of venous thrombotic events of the included patients were observed. Results A total of 60 patients were included, including 41 males and 19 females; 30 cases in each group. There was no statistically significant difference in gender, age, body mass index, surgical approach, and surgical duration between the two groups of patients (P>0.05). There were statistically significant differences in total blood loss [(795.90±451.36) vs. (579.70±315.88) mL], 48 h postoperative blood drainage [(231.33±130.77) vs. (147.67±73.14) mL], recessive blood loss [(406.23±356.17) vs. (170.30±163.75) mL], and transfusion rate (63.3% vs. 36.7%) between the control group and the experimental group (P<0.05). There was no statistically significant difference in the preoperative incidence of intramuscular vein thrombosis and the postoperative incidence of deep vein thrombosis and intramuscular vein thrombosis between the two groups of patients (P>0.05). All patients did not experience pulmonary embolism after surgery. The hemoglobin and hematocrit of both groups showed a decreasing trend. But there was no statistically significant difference in hemoglobin and hematocrit between the two groups (P＞0.05). Both groups showed different trends in fibrinogen and D-dimer, and the experimental group was better than the control group (P<0.05). Conclusion Multiple intravenous administration of TXA in complex acetabular fractures patients has proven to decrease the total and hidden blood loss, decrease perioperative blood products transfusion rate, and do not expose to venous thrombotic diseases risks.

Citation： YU You, ZOU Chang, TAN Peng, Guy Romeo Kenmegne, YIN Yijie, HUANG Shenbo, HE Shuai, FANG Yue. Evaluation of efficacy and safety of perioperative multiple intravenous tranexamic acid administration in complex acetabular fractures. West China Medical Journal, 2024, 39(3): 461-467. doi: 10.7507/1002-0179.202311281 Copy

1.	McGee A, Obinwa C, White P, et al. Preoperative blood loss of isolated acetabular fractures. J Orthop Trauma, 2023, 37(3): 116-121.
2.	Ucieklak J, Rapala K, Obrebski M. The Judet and Letournel classification of acetabular fractures. Chir Narzadow Ruchu Ortop Pol, 2000, 65(2): 203-208.
3.	Dündar A, İpek D, Kaya Ş. Acetabular fractures from judet and letournel to the present: research trends and global outcomes with bibliometric analysis during 1980 to 2022. Medicine (Baltimore), 2023, 102(29): e34297.
4.	Kelly J, Ladurner A, Rickman M. Surgical management of acetabular fractures - a contemporary literature review. Injury, 2020, 51(10): 2267-2277.
5.	邹昌, 方跃, 屠重棋, 等. 改良 Stoppa 入路联合髂窝入路治疗复杂髋臼骨折. 中华创伤骨科杂志, 2015, 17(8): 669-675.
6.	Shu HT, Mikula JD, Yu AT, et al. Tranexamic acid use in pelvic and/or acetabular fracture surgery: a systematic review and meta-analysis. J Orthop, 2021, 28: 112-116.
7.	Kashyap S, Mahajan S, Lal M. Effects of topical tranexamic acid during open reduction and internal fixation of acetabular fractures: a retrospective study. Acta Orthop Traumatol Turc, 2019, 53(3): 175-179.
8.	Wadhwa H, Tigchelaar SS, Chen MJ, et al. Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery. Eur J Orthop Surg Traumatol, 2021, 32(2): 363-369.
9.	王钢. 骨盆与髋臼骨折的治疗进展及思考. 中华创伤骨科杂志, 2018, 20(3): 185-186.
10.	中国康复技术转化及发展促进会, 中国研究型医院学会关节外科学专业委员会, 中国医疗保健国际交流促进会关节疾病防治分会, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
11.	Spitler CA, Row ER, Gardner WE 2nd, et al. Tranexamic acid use in open reduction and internal fixation of fractures of the pelvis, acetabulum, and proximal femur: a randomized controlled trial. J Orthop Trauma, 2019, 33(8): 371-376.
12.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016, 36(2): 65-71.
13.	朱明艳, 冯虹, 任舒, 等. 不同输血指征对重症监护病人预后的影响. 中国老年学杂志, 2011, 31(10): 1755-1757.
14.	Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
15.	柳志红. 2019 欧洲心脏病学会《急性肺栓塞诊断和治疗指南》解读. 中国循环杂志, 2019, 34(12): 1155-1157.
16.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
18.	Bigsby E, Acharya MR, Ward AJ, et al. The use of blood cell salvage in acetabular fracture internal fixation surgery. J Orthop Trauma, 2013, 27(10): e230-e233.
19.	王百盛, 李如珍, 韩文锋, 等. 联合应用重组人促红细胞生成素与蔗糖铁治疗初次全髋关节置换围术期贫血的疗效分析. 创伤外科杂志, 2019, 21(3): 192-196, 200.
20.	周宗科, 翁习生, 孙天胜, 等. 中国骨科手术加速康复——围术期血液管理专家共识. 中华骨与关节外科杂志, 2017, 10(1): 1-7.
21.	Andersson L, Eriksson O, Hedlund PO, et al. Special considerations with regard to the dosage of tranexamic acid in patients with chronic renal diseases. Urol Res, 1978, 6(2): 83-88.
22.	Xie J, Ma J, Yao H, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: a randomized clinical trial. J Arthroplasty, 2016, 31(11): 2458-2464.
23.	姚欢, 谢锦伟, 岳辰, 等. 多次重复静脉应用氨甲环酸减少初次全髋关节置换术失血有效性与安全性的前瞻性对照研究. 中国骨与关节杂志, 2016, 5(12): 885-890.
24.	Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res, 2012, 470(9): 2605-2612.
25.	Johansson T, Pettersson L G, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop, 2005, 76(3): 314-319.
26.	Lei Y, Huang Q, Huang Z, et al. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2018, 33(9): 2940-2945.
27.	Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic acid in patients undergoing noncardiac surgery. N Engl J Med, 2022, 386(21): 1986-1997.
28.	Sentilhes L, Winer N, Azria E, et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med, 2018, 379(8): 731-742.
29.	Zhang J, Zhao R, Huang Y, et al. The application of tranexamic acid in joint arthroplasty: a 20-year bibliometric analysis. Front Public Health, 2022, 10: 1013461.
30.	Fraval A, Effeney P, Fiddelaers L, et al. Obtain a: outcome benefits of tranexamic acid in hip arthroplasty. A randomized double-blinded controlled trial. J Arthroplasty, 2017, 32(5): 1516-1519.
31.	解京明, 李韬, 王迎松, 等. 大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性. 中国脊柱脊髓杂志, 2016, 26(1): 48-54.
32.	许宏, 张少云, 雷一霆, 等. 全膝关节置换术后多次静脉应用氨甲环酸的有效性及安全性. 中国矫形外科杂志, 2018, 26(7): 604-609.
33.	Lei YT, Xie JW, Huang Q, et al. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop, 2020, 44(3): 477-486.
34.	Clohisy JCF, Lenke LG, Dafrawy MHE, et al. Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery. Spine Deform, 2022, 10(6): 1399-1406.
35.	Roberts I, Shakur-Still H, Afolabi A, et al. A high-dose 24-hour tranexamic acid infusion for the treatment of significant gastrointestinal bleeding: HALT-IT RCT. Health Technol Assess, 2021, 25(58): 1-86.

1. McGee A, Obinwa C, White P, et al. Preoperative blood loss of isolated acetabular fractures. J Orthop Trauma, 2023, 37(3): 116-121.
2. Ucieklak J, Rapala K, Obrebski M. The Judet and Letournel classification of acetabular fractures. Chir Narzadow Ruchu Ortop Pol, 2000, 65(2): 203-208.
3. Dündar A, İpek D, Kaya Ş. Acetabular fractures from judet and letournel to the present: research trends and global outcomes with bibliometric analysis during 1980 to 2022. Medicine (Baltimore), 2023, 102(29): e34297.
4. Kelly J, Ladurner A, Rickman M. Surgical management of acetabular fractures - a contemporary literature review. Injury, 2020, 51(10): 2267-2277.
5. 邹昌, 方跃, 屠重棋, 等. 改良 Stoppa 入路联合髂窝入路治疗复杂髋臼骨折. 中华创伤骨科杂志, 2015, 17(8): 669-675.
6. Shu HT, Mikula JD, Yu AT, et al. Tranexamic acid use in pelvic and/or acetabular fracture surgery: a systematic review and meta-analysis. J Orthop, 2021, 28: 112-116.
7. Kashyap S, Mahajan S, Lal M. Effects of topical tranexamic acid during open reduction and internal fixation of acetabular fractures: a retrospective study. Acta Orthop Traumatol Turc, 2019, 53(3): 175-179.
8. Wadhwa H, Tigchelaar SS, Chen MJ, et al. Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery. Eur J Orthop Surg Traumatol, 2021, 32(2): 363-369.
9. 王钢. 骨盆与髋臼骨折的治疗进展及思考. 中华创伤骨科杂志, 2018, 20(3): 185-186.
10. 中国康复技术转化及发展促进会, 中国研究型医院学会关节外科学专业委员会, 中国医疗保健国际交流促进会关节疾病防治分会, 等. 中国骨科手术加速康复围手术期氨甲环酸与抗凝血药应用的专家共识. 中华骨与关节外科杂志, 2019, 12(2): 81-88.
11. Spitler CA, Row ER, Gardner WE 2nd, et al. Tranexamic acid use in open reduction and internal fixation of fractures of the pelvis, acetabulum, and proximal femur: a randomized controlled trial. J Orthop Trauma, 2019, 33(8): 371-376.
12. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016, 36(2): 65-71.
13. 朱明艳, 冯虹, 任舒, 等. 不同输血指征对重症监护病人预后的影响. 中国老年学杂志, 2011, 31(10): 1755-1757.
14. Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
15. 柳志红. 2019 欧洲心脏病学会《急性肺栓塞诊断和治疗指南》解读. 中国循环杂志, 2019, 34(12): 1155-1157.
16. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
18. Bigsby E, Acharya MR, Ward AJ, et al. The use of blood cell salvage in acetabular fracture internal fixation surgery. J Orthop Trauma, 2013, 27(10): e230-e233.
19. 王百盛, 李如珍, 韩文锋, 等. 联合应用重组人促红细胞生成素与蔗糖铁治疗初次全髋关节置换围术期贫血的疗效分析. 创伤外科杂志, 2019, 21(3): 192-196, 200.
20. 周宗科, 翁习生, 孙天胜, 等. 中国骨科手术加速康复——围术期血液管理专家共识. 中华骨与关节外科杂志, 2017, 10(1): 1-7.
21. Andersson L, Eriksson O, Hedlund PO, et al. Special considerations with regard to the dosage of tranexamic acid in patients with chronic renal diseases. Urol Res, 1978, 6(2): 83-88.
22. Xie J, Ma J, Yao H, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss after primary total knee arthroplasty without tourniquet: a randomized clinical trial. J Arthroplasty, 2016, 31(11): 2458-2464.
23. 姚欢, 谢锦伟, 岳辰, 等. 多次重复静脉应用氨甲环酸减少初次全髋关节置换术失血有效性与安全性的前瞻性对照研究. 中国骨与关节杂志, 2016, 5(12): 885-890.
24. Maniar RN, Kumar G, Singhi T, et al. Most effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res, 2012, 470(9): 2605-2612.
25. Johansson T, Pettersson L G, Lisander B. Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients. Acta Orthop, 2005, 76(3): 314-319.
26. Lei Y, Huang Q, Huang Z, et al. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: a randomized controlled trial. J Arthroplasty, 2018, 33(9): 2940-2945.
27. Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic acid in patients undergoing noncardiac surgery. N Engl J Med, 2022, 386(21): 1986-1997.
28. Sentilhes L, Winer N, Azria E, et al. Tranexamic acid for the prevention of blood loss after vaginal delivery. N Engl J Med, 2018, 379(8): 731-742.
29. Zhang J, Zhao R, Huang Y, et al. The application of tranexamic acid in joint arthroplasty: a 20-year bibliometric analysis. Front Public Health, 2022, 10: 1013461.
30. Fraval A, Effeney P, Fiddelaers L, et al. Obtain a: outcome benefits of tranexamic acid in hip arthroplasty. A randomized double-blinded controlled trial. J Arthroplasty, 2017, 32(5): 1516-1519.
31. 解京明, 李韬, 王迎松, 等. 大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性. 中国脊柱脊髓杂志, 2016, 26(1): 48-54.
32. 许宏, 张少云, 雷一霆, 等. 全膝关节置换术后多次静脉应用氨甲环酸的有效性及安全性. 中国矫形外科杂志, 2018, 26(7): 604-609.
33. Lei YT, Xie JW, Huang Q, et al. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop, 2020, 44(3): 477-486.
34. Clohisy JCF, Lenke LG, Dafrawy MHE, et al. Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery. Spine Deform, 2022, 10(6): 1399-1406.
35. Roberts I, Shakur-Still H, Afolabi A, et al. A high-dose 24-hour tranexamic acid infusion for the treatment of significant gastrointestinal bleeding: HALT-IT RCT. Health Technol Assess, 2021, 25(58): 1-86.

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Evaluation of efficacy and safety of perioperative multiple intravenous tranexamic acid administration in complex acetabular fractures

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