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.	李銳博, 尹詩九, 鐘航, 等. 靜脈聯合關節腔內注射氨甲環酸后引流管夾閉時間對人工全膝關節置換術后失血量的影響及安全性評價. 中國修復重建外科雜志, 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, 許宏, 等. 人工全髖關節置換術中首次大劑量聯合術后五次靜脈應用氨甲環酸的前瞻性臨床研究. 中國修復重建外科雜志, 2019, 33(8): 935-939.
10.	黃勇, 劉俊賓, 房好林. 初次髖關節置換患者氨甲環酸不同給藥途徑比較的前瞻性研究. 中國骨與關節雜志, 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, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復——圍術期疼痛與睡眠管理專家共識. 中國骨與關節外科雜志, 2016, 9(2): 91-97.
15.	康鵬德, 王浩洋, 沈彬, 等. 加入局部浸潤鎮痛的多模式鎮痛在全膝關節置換中的應用. 中華骨科雜志, 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.	劉改霞, 孫雨瑤, 陳子璐, 等. 炎性疼痛對小鼠外周組織炎癥反應及 TNF-α 和 MCP-1 表達的影響. 西安交通大學學報 (醫學版), 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.	吳俊, 李廣翼, 陳云蘇, 等. 三種氨甲環酸聯合用藥方案在初次人工全膝關節置換術中的療效比較. 中國修復重建外科雜志, 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. 李銳博, 尹詩九, 鐘航, 等. 靜脈聯合關節腔內注射氨甲環酸后引流管夾閉時間對人工全膝關節置換術后失血量的影響及安全性評價. 中國修復重建外科雜志, 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, 許宏, 等. 人工全髖關節置換術中首次大劑量聯合術后五次靜脈應用氨甲環酸的前瞻性臨床研究. 中國修復重建外科雜志, 2019, 33(8): 935-939.
10. 黃勇, 劉俊賓, 房好林. 初次髖關節置換患者氨甲環酸不同給藥途徑比較的前瞻性研究. 中國骨與關節雜志, 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, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復——圍術期疼痛與睡眠管理專家共識. 中國骨與關節外科雜志, 2016, 9(2): 91-97.
15. 康鵬德, 王浩洋, 沈彬, 等. 加入局部浸潤鎮痛的多模式鎮痛在全膝關節置換中的應用. 中華骨科雜志, 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. 劉改霞, 孫雨瑤, 陳子璐, 等. 炎性疼痛對小鼠外周組織炎癥反應及 TNF-α 和 MCP-1 表達的影響. 西安交通大學學報 (醫學版), 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. 吳俊, 李廣翼, 陳云蘇, 等. 三種氨甲環酸聯合用藥方案在初次人工全膝關節置換術中的療效比較. 中國修復重建外科雜志, 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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