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, ?pek D, Kaya ?. 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.	鄒昌, 方躍, 屠重棋, 等. 改良 Stoppa 入路聯合髂窩入路治療復雜髖臼骨折. 中華創傷骨科雜志, 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.	王鋼. 骨盆與髖臼骨折的治療進展及思考. 中華創傷骨科雜志, 2018, 20(3): 185-186.
10.	中國康復技術轉化及發展促進會, 中國研究型醫院學會關節外科學專業委員會, 中國醫療保健國際交流促進會關節疾病防治分會, 等. 中國骨科手術加速康復圍手術期氨甲環酸與抗凝血藥應用的專家共識. 中華骨與關節外科雜志, 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.	中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016, 36(2): 65-71.
13.	朱明艷, 馮虹, 任舒, 等. 不同輸血指征對重癥監護病人預后的影響. 中國老年學雜志, 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.	柳志紅. 2019 歐洲心臟病學會《急性肺栓塞診斷和治療指南》解讀. 中國循環雜志, 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, 韓文鋒, 等. 聯合應用重組人促紅細胞生成素與蔗糖鐵治療初次全髖關節置換圍術期貧血的療效分析. 創傷外科雜志, 2019, 21(3): 192-196, 200.
20.	周宗科, 翁習生, 孫天勝, 等. 中國骨科手術加速康復——圍術期血液管理專家共識. 中華骨與關節外科雜志, 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.	姚歡, 謝錦偉, 岳辰, 等. 多次重復靜脈應用氨甲環酸減少初次全髖關節置換術失血有效性與安全性的前瞻性對照研究. 中國骨與關節雜志, 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, 李韜, 王迎松, 等. 大劑量氨甲環酸用于脊柱矯形手術的安全性和有效性. 中國脊柱脊髓雜志, 2016, 26(1): 48-54.
32.	許宏, 張少云, 雷一霆, 等. 全膝關節置換術后多次靜脈應用氨甲環酸的有效性及安全性. 中國矯形外科雜志, 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, ?pek D, Kaya ?. 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. 鄒昌, 方躍, 屠重棋, 等. 改良 Stoppa 入路聯合髂窩入路治療復雜髖臼骨折. 中華創傷骨科雜志, 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. 王鋼. 骨盆與髖臼骨折的治療進展及思考. 中華創傷骨科雜志, 2018, 20(3): 185-186.
10. 中國康復技術轉化及發展促進會, 中國研究型醫院學會關節外科學專業委員會, 中國醫療保健國際交流促進會關節疾病防治分會, 等. 中國骨科手術加速康復圍手術期氨甲環酸與抗凝血藥應用的專家共識. 中華骨與關節外科雜志, 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. 中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016, 36(2): 65-71.
13. 朱明艷, 馮虹, 任舒, 等. 不同輸血指征對重癥監護病人預后的影響. 中國老年學雜志, 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. 柳志紅. 2019 歐洲心臟病學會《急性肺栓塞診斷和治療指南》解讀. 中國循環雜志, 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, 韓文鋒, 等. 聯合應用重組人促紅細胞生成素與蔗糖鐵治療初次全髖關節置換圍術期貧血的療效分析. 創傷外科雜志, 2019, 21(3): 192-196, 200.
20. 周宗科, 翁習生, 孫天勝, 等. 中國骨科手術加速康復——圍術期血液管理專家共識. 中華骨與關節外科雜志, 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. 姚歡, 謝錦偉, 岳辰, 等. 多次重復靜脈應用氨甲環酸減少初次全髖關節置換術失血有效性與安全性的前瞻性對照研究. 中國骨與關節雜志, 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, 李韜, 王迎松, 等. 大劑量氨甲環酸用于脊柱矯形手術的安全性和有效性. 中國脊柱脊髓雜志, 2016, 26(1): 48-54.
32. 許宏, 張少云, 雷一霆, 等. 全膝關節置換術后多次靜脈應用氨甲環酸的有效性及安全性. 中國矯形外科雜志, 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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