Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Qingyan , XIANG Chao , CHEN Xiaoting , CHEN Lin , CHEN Qian , JIANG Ke , CHEN Lu ,  LI Yuling ,  WEI Peng

Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong Sichuan, 637000, P.R.China;

Corresponding author：

LI Yuling, Email: 1048093747@qq.com; WEI Peng, Email: weipeng789@163.com

Keywords：

Intertrochanteric fracture; tranexamic acid; cocktail therapy; blood loss; internal fixation; perioperative period

DOI：

10.7507/1002-1892.201908138

Video：

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Objective To explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA).Methods Patients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups (n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups (P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups.Results The total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A (P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B (P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups (P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B (P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups (P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups (χ²=1.721, P=0.550).Conclusion For intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.

Citation： ZHANG Qingyan, XIANG Chao, CHEN Xiaoting, CHEN Lin, CHEN Qian, JIANG Ke, CHEN Lu, LI Yuling, WEI Peng. Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 463-468. doi: 10.7507/1002-1892.201908138 Copy

1.	Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia, 2015, 70(Suppl 1): 50-53, e18.
2.	李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
3.	Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct meta-analysis. J Arthroplasty, 2018, 33(1): 3070-3082.e1.
4.	Ahmad R, Hashem Q, Ziad A, et al. Functional and radiological results of proximal femoral nail antirotation (PFNA) osteosynthesis in the treatment of unstable pertrochanteric fractures. J Clin Med, 2018, 7(4): 78.
5.	Zang W, Liu PF, Han XF. A comparative study of proximal femoral locking compress plate, proximal femoral nail antirotation and dynamic hip screw in intertrochanteric fractures. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl): 119-123.
6.	Tian S, Li H, Liu M, et al. Dynamic analysis of perioperative hidden blood loss in intertrochanteric fractures. Clin Appl Thromb Hemost, 2019, 25: 1076029618823279.
7.	Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124.
8.	Zhou XD, Zhang Y, Jiang LF, et al. Efficacy and safety of tranexamic acid in intertrochanteric fractures: A single-blind randomized controlled trial. Orthop Surg, 2019, 11(4): 635-641.
9.	崔丹荔, 雷一霆, 许宏, 等. 人工全髋关节置换术中首次大剂量联合术后五次静脉应用氨甲环酸的前瞻性临床研究. 中国修复重建外科杂志, 2019, 33(8): 935-939.
10.	黄勇, 刘俊宾, 房好林. 初次髋关节置换患者氨甲环酸不同给药途径比较的前瞻性研究. 中国骨与关节杂志, 2018, 7(12): 885-890.
11.	Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J, 2014, 96-B(8): 1005-1015.
12.	Zhang P, L JF, Wang X. Combined versus single application of tranexamic acid in total knee and hip arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg, 2017, 43: 171-180.
13.	Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg, 2019, 32(2): 121-128.
14.	沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中国骨与关节外科杂志, 2016, 9(2): 91-97.
15.	康鹏德, 王浩洋, 沈彬, 等. 加入局部浸润镇痛的多模式镇痛在全膝关节置换中的应用. 中华骨科杂志, 2013, 33(3): 246-251.
16.	Walker PF, Foster AD, Rothberg PA, et al. Tranexamic acid decreases rodent hemorrhagic shock-induced inflammation with mixed end-organ effects. PLoS One, 2018, 13(11): e0208249.
17.	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.
18.	Taleb-Belkadi O, Chaib H, Zemour L, et al. Lipid profile, inflammation, and oxidative status in peri- and postmenopausal women. Gynecological Endocrinology, 2016, 32(12): 982-985.
19.	Yue T, Zhao P, Lu L, et al. Pre-emptive parecoxib and post-operative cognitive function in elderly patients. International Psychogeriatrics, 2015, 27(2): 329-336.
20.	Zheng C, Qu YX, Wang B, et al. COX-2/PGE2 facilitates fracture healing by activating the Wnt/β-catenin signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(22): 9721-9728.
21.	Sugita R, Kuwabara H, Kubota K, et al. Simultaneous inhibition of PGE 2 and PGI 2 signals is necessary to suppress hyperalgesia in rat inflammatory pain models. Mediators of Inflammation, 2016, 2016(3): 1-10.
22.	刘改霞, 孙雨瑶, 陈子璐, 等. 炎性疼痛对小鼠外周组织炎症反应及 TNF-α 和 MCP-1 表达的影响. 西安交通大学学报 (医学版), 2019, 40(1): 65-70.
23.	Stowers MDJ, Aoina J, Vane A, et al. Tranexamic acid in knee surgery study—A multicentered, randomized, controlled trial. J Arthroplasty, 2017, 32(11): 3379-3384.
24.	吴俊, 李广翼, 陈云苏, 等. 三种氨甲环酸联合用药方案在初次人工全膝关节置换术中的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1397-1401.
25.	Cotton BA, Minei KM, Radwan ZA, et al. Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients. J Trauma Acute Care Surg, 2012, 72(6): 1470-1477.

1. Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia, 2015, 70(Suppl 1): 50-53, e18.
2. 李锐博, 尹诗九, 钟航, 等. 静脉联合关节腔内注射氨甲环酸后引流管夹闭时间对人工全膝关节置换术后失血量的影响及安全性评价. 中国修复重建外科杂志, 2017, 31(4): 417-421.
3. Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct meta-analysis. J Arthroplasty, 2018, 33(1): 3070-3082.e1.
4. Ahmad R, Hashem Q, Ziad A, et al. Functional and radiological results of proximal femoral nail antirotation (PFNA) osteosynthesis in the treatment of unstable pertrochanteric fractures. J Clin Med, 2018, 7(4): 78.
5. Zang W, Liu PF, Han XF. A comparative study of proximal femoral locking compress plate, proximal femoral nail antirotation and dynamic hip screw in intertrochanteric fractures. Eur Rev Med Pharmacol Sci, 2018, 22(1 Suppl): 119-123.
6. Tian S, Li H, Liu M, et al. Dynamic analysis of perioperative hidden blood loss in intertrochanteric fractures. Clin Appl Thromb Hemost, 2019, 25: 1076029618823279.
7. Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124.
8. Zhou XD, Zhang Y, Jiang LF, et al. Efficacy and safety of tranexamic acid in intertrochanteric fractures: A single-blind randomized controlled trial. Orthop Surg, 2019, 11(4): 635-641.
9. 崔丹荔, 雷一霆, 许宏, 等. 人工全髋关节置换术中首次大剂量联合术后五次静脉应用氨甲环酸的前瞻性临床研究. 中国修复重建外科杂志, 2019, 33(8): 935-939.
10. 黄勇, 刘俊宾, 房好林. 初次髋关节置换患者氨甲环酸不同给药途径比较的前瞻性研究. 中国骨与关节杂志, 2018, 7(12): 885-890.
11. Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J, 2014, 96-B(8): 1005-1015.
12. Zhang P, L JF, Wang X. Combined versus single application of tranexamic acid in total knee and hip arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg, 2017, 43: 171-180.
13. Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg, 2019, 32(2): 121-128.
14. 沈彬, 翁习生, 廖刃, 等. 中国髋、膝关节置换术加速康复——围术期疼痛与睡眠管理专家共识. 中国骨与关节外科杂志, 2016, 9(2): 91-97.
15. 康鹏德, 王浩洋, 沈彬, 等. 加入局部浸润镇痛的多模式镇痛在全膝关节置换中的应用. 中华骨科杂志, 2013, 33(3): 246-251.
16. Walker PF, Foster AD, Rothberg PA, et al. Tranexamic acid decreases rodent hemorrhagic shock-induced inflammation with mixed end-organ effects. PLoS One, 2018, 13(11): e0208249.
17. 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.
18. Taleb-Belkadi O, Chaib H, Zemour L, et al. Lipid profile, inflammation, and oxidative status in peri- and postmenopausal women. Gynecological Endocrinology, 2016, 32(12): 982-985.
19. Yue T, Zhao P, Lu L, et al. Pre-emptive parecoxib and post-operative cognitive function in elderly patients. International Psychogeriatrics, 2015, 27(2): 329-336.
20. Zheng C, Qu YX, Wang B, et al. COX-2/PGE2 facilitates fracture healing by activating the Wnt/β-catenin signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(22): 9721-9728.
21. Sugita R, Kuwabara H, Kubota K, et al. Simultaneous inhibition of PGE 2 and PGI 2 signals is necessary to suppress hyperalgesia in rat inflammatory pain models. Mediators of Inflammation, 2016, 2016(3): 1-10.
22. 刘改霞, 孙雨瑶, 陈子璐, 等. 炎性疼痛对小鼠外周组织炎症反应及 TNF-α 和 MCP-1 表达的影响. 西安交通大学学报 (医学版), 2019, 40(1): 65-70.
23. Stowers MDJ, Aoina J, Vane A, et al. Tranexamic acid in knee surgery study—A multicentered, randomized, controlled trial. J Arthroplasty, 2017, 32(11): 3379-3384.
24. 吴俊, 李广翼, 陈云苏, 等. 三种氨甲环酸联合用药方案在初次人工全膝关节置换术中的疗效比较. 中国修复重建外科杂志, 2018, 32(11): 1397-1401.
25. Cotton BA, Minei KM, Radwan ZA, et al. Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients. J Trauma Acute Care Surg, 2012, 72(6): 1470-1477.

Chinese Journal of Reparative and Reconstructive Surgery

Application of intravenous injection of tranexamic acid combined with local use of tranexamic acid cocktail in intertrochanteric fracture fixation

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