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Wadhwa H, Rohde M, Oquendo Y, Chen MJ, Tigchelaar SS, Bellino M, Bishop J, Gardner MJ. Interaction of preoperative chemoprophylaxis and tranexamic acid use does not affect transfusion in acetabular fracture surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1025-1029. [PMID: 37865628 DOI: 10.1007/s00590-023-03763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE While the effects of tranexamic acid (TXA) use on transfusion rates after acetabular fracture surgery are unclear, previous evidence suggests that holding deep vein thrombosis (DVT) chemoprophylaxis may improve TXA efficacy. This study examines whether holding DVT chemoprophylaxis in patients receiving TXA affects intraoperative and postoperative transfusion rates in acetabular fracture surgery. METHODS We reviewed electronic medical records (EMR) of 305 patients who underwent open reduction and internal fixation of acetabular fractures (AO/OTA 62) and stratified patients per the following perioperative treatment: (1) no intraoperative TXA (noTXA), (2) intraoperative TXA and no preoperative DVT prophylaxis (opTXA/noDVTP), or (3) intraoperative TXA and preoperative DVT prophylaxis (opTXA/opDVTP). The primary outcomes were need for intraoperative or postoperative transfusion. Risk factors for each primary outcome were assessed using multivariable regression. RESULTS Intraoperative or postoperative transfusion rates did not significantly differ between opTXA/opDVTP and opTXA/noDVTP groups (46.2% vs. 36%, p = 0.463; 15.4% vs. 28%, p = 0.181). Median units transfused did not differ between groups (2 ± 1 vs. 2 ± 1, p = 0.515; 2 ± 1 vs. 2 ± 0, p = 0.099). There was no association between preoperative DVT chemoprophylaxis and TXA with intraoperative or postoperative transfusions. EBL, preoperative hematocrit, and IV fluids were associated with intraoperative transfusions; age and Charlson Comorbidity Index (CCI) were associated with postoperative transfusions. CONCLUSION Our findings suggest holding DVT prophylaxis did not alter the effect of TXA on blood loss or need for transfusion.
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Affiliation(s)
- Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Matthew Rohde
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Yousi Oquendo
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael Bellino
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Julius Bishop
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
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Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Banneyake EL, Gunasekera IS, Fang Y. A prophylactic TXA administration effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures. Sci Rep 2023; 13:12570. [PMID: 37532829 PMCID: PMC10397234 DOI: 10.1038/s41598-023-39873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023] Open
Abstract
This study aimed to evaluate the efficacy of perioperative intravenous TXA in reducing blood loss in pelvic and acetabular fracture patients managed surgically. The study included 306 consecutive patients, divided as: group I, 157 patients who did not receive perioperative infusion of TXA and group II, 149 patients who received perioperative TXA. The perioperative blood test results and complication rates were compared between the two groups. The average perioperative hematocrit was higher during the preoperative period than during the first, second and third postoperative day in both groups. In the estimated blood loss between the two groups, there was a significant difference of 1391 (± 167.49) ml in group I and 725 (± 403.31) ml in group II respectively (p = 0.02). No significant difference was seen in the total of intraoperative transfusion units as well as in the total units of blood transfused. There was a reduced level of postoperative hemoglobin (9.28 ± 17.88 g/dl in group I and 10.06 ± 27.57 g/dl in group II compared to the values obtained in preoperative investigations (10.4 ± 2.37 g/dl in group I and 11.4 ± 2.08 g/dl in group II); with a significant difference in postoperative transfusion rates (p = 0.03). Therefore, the use of TXA effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures.
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Affiliation(s)
- Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yixiang Lin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yijie Yin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shenbo Huang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Erandathie Lasanda Banneyake
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Imani Savishka Gunasekera
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Chowdhury D. To Assess the Outcomes Associated With the Use of Tranexamic Acid in the Open Fixation of Pelvic and Acetabular Fractures. Cureus 2023; 15:e38232. [PMID: 37261178 PMCID: PMC10226826 DOI: 10.7759/cureus.38232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
There is a growing knowledge base for the use of antifibrinolytic therapy in trauma and orthopaedic surgery. The mechanism of action of tranexamic acid (TXA) is through the inhibition of fibrinolysis. The role of TXA in hip fractures has been researched extensively. However, the research has been limited to the cases of pelvic and acetabular fractures. This systematic review aimed to examine the effect of TXA on patients undergoing open pelvic and acetabular fracture surgery. The primary goal of the study was to examine the estimated blood loss (EBL) and blood transfusion rates in patients who received TXA versus those who did not receive TXA. The secondary goal was to examine the rates of deep venous thrombosis (DVT). A literature search was carried out using PubMed, Medline and the Cochrane database. The selection criteria for the systematic review were studies investigating intravenous TXA in the form of randomised controlled trials (RCTs), as well as cohort studies. Five studies were included in the systematic review with 625 total patients. The EBL between the two groups was noted to be 661 mL in the control group and 850 mL in the TXA (p=0.49). There was a marginally lower number of units transfused in the control group vs the TXA group (1.9 vs 2.2) (p=0.27). The rates of transfusion in the TXA group were 29% TXA whilst, in the control group, it was 31% (p=0.13). The overall incidence of DVT was 2.8% in the TXA group and 1.7% in the control group (p=0.097).
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Affiliation(s)
- Debkumar Chowdhury
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, GBR
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Yakkanti RR, Mohile NV, Cohen-Levy WB, Haziza S, Lavelle MJ, Bellam KG, Quinnan SM. Perioperative management of acetabular and pelvic fractures: evidence-based recommendations. Arch Orthop Trauma Surg 2023; 143:1311-1321. [PMID: 34854977 DOI: 10.1007/s00402-021-04278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.
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Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Neil V Mohile
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | | | - Sagie Haziza
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA.
| | - Matthew J Lavelle
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Krishna G Bellam
- Warren Alpert Medical School at Brown University, Providence, RI, USA
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Shu HT, Mikula JD, Yu AT, Shafiq B. Tranexamic acid use in pelvic and/or acetabular fracture surgery: A systematic review and meta-analysis. J Orthop 2021; 28:112-116. [PMID: 34924726 DOI: 10.1016/j.jor.2021.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/28/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose The purpose of this study is to determine whether tranexamic acid (TXA) use was associated with lower rates of blood transfusion in patients undergoing pelvic and/or acetabular fracture surgery. Methods Four studies were included, 3 of which were included in the pooled data analysis for a total of 308 patients. Results The transfusion rate was significantly lower in the TXA group (44%) compared with the non-TXA group (57%) (P = 0.02). Conclusion TXA use was associated with a significantly lower transfusion rate in patients who underwent pelvic and/or acetabular fracture surgery. Level of evidence Level 3. Systematic review of retrospective cohort studies and prospective randomized controlled trials.
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Affiliation(s)
- Henry T Shu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jacob D Mikula
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew T Yu
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Viberg B. Tranexamic Acid: When is It Indicated in Orthopaedic Surgery? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34902870 DOI: 10.1055/a-1666-9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tranexamic acid (TXA) has been studied extensively during the last 5-8 years. It inhibits clot dissolution during surgery and can therefore reduce blood loss. However, there has been concern that this could result in more frequent complications, specifically in terms of thromboembolic events. The indications for TXA are widespread, and this review covers the literature on orthopaedic indications such as joint replacement, fracture surgery, and arthroscopic procedures. In general, TXA is safe and can be used in a wide variety of orthopaedic procedures, lowering blood loss without increasing the risk of complications.
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Affiliation(s)
- Bjarke Viberg
- Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University Hospital of Southern Denmark, Kolding, Denmark.,Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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About anesthesiology and surgery: analgesia, anaesthesia, and non-surgical papers published in journals of surgery. INTERNATIONAL ORTHOPAEDICS 2021; 45:2763-2764. [PMID: 34705060 DOI: 10.1007/s00264-021-05252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perskin CR, Littlefield CP, Wang C, Umeh U, Egol KA. The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery. JBJS Rev 2021; 9:01874474-202107000-00009. [PMID: 34270510 DOI: 10.2106/jbjs.rvw.20.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Tranexamic acid (TXA) is a drug used to control hemorrhage by preventing the breakdown of fibrin. » TXA is a cost-effective treatment for trauma patients across a variety of economic settings. » Concerns of TXA causing thromboembolic events (TEEs) in orthopaedic trauma patients are not supported by evidence. » TXA has been shown to reduce blood loss in hip fracture surgery.
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Xu C, Wu M, Wang Z, Liu Y, Zhou P, Guan J. Efficacy of repeated intravenous tranexamic acid in reducing perioperative bleeding of acetabular fractures. Clin Hemorheol Microcirc 2021; 79:567-573. [PMID: 34151780 DOI: 10.3233/ch-211203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Application of tranexamic acid (TXA) in the treatment of acetabular fractures could reduce intraoperative and postoperative blood loss. OBJECTIVE To investigate the effect of single and repeated intravenous infusion of TXA on blood loss of acetabular fractures. METHODS 120 patients with acetabular fractures admitted to our hospital from January 2017 to September 2020 were retrospectively divided into three groups: Patients accepted 1g TXA at preoperative 30 minutes were defined as single TXA group (n = 40); Patients accepted 1g TXA at preoperative 30 minutes and 1g TXA at 3 hours after the start of surgery were defined as repeated TXA group (n = 40); Patients accepted normal saline at preoperative 30 minutes were defined as control group (n = 40). RESULTS The total blood loss in single TXA group and repeated TXA group were significantly lower than control group, and the total blood loss in the repeated TXA group was significantly lower than single TXA group (P < 0.05). The hidden blood loss from surgery to postoperative 1 day in repeated TXA group was significantly lower than single TXA group and the control group(P < 0.05). No significant differences were observed in the operative time, postoperative transfusion rate and thrombosis rate among the three groups (P > 0.05). CONCLUSION Repeated TXA is more recommended during acetabular fracture surgery since it can reduce the total blood loss without increasing the operative time, postoperative transfusion rate and thrombosis rate compared with single TXA.
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Affiliation(s)
- Chen Xu
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Min Wu
- Department of Orthopedics, Bengbu Medical University Affiliated to First Hospital, Bengbu, Anhui Province, China
| | - Zhaodong Wang
- Department of Orthopedics, Bengbu Medical University Affiliated to First Hospital, Bengbu, Anhui Province, China
| | - Yajun Liu
- Department of Orthopedics, Bengbu Medical University Affiliated to First Hospital, Bengbu, Anhui Province, China
| | - Pinghui Zhou
- Department of Orthopedics, Bengbu Medical University Affiliated to First Hospital, Bengbu, Anhui Province, China
| | - Jianzhong Guan
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.,Department of Orthopedics, Bengbu Medical University Affiliated to First Hospital, Bengbu, Anhui Province, China
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Wadhwa H, Tigchelaar SS, Chen MJ, Koltsov JCB, Bellino MJ, Bishop JA, Gardner MJ. Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:363-369. [PMID: 33891154 DOI: 10.1007/s00590-021-02985-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Tranexamic acid (TXA) reduces need for transfusion in total joint arthroplasty, though findings in acetabular surgery are conflicting. We compared outcomes after acetabular fracture surgery with or without perioperative intravenous (IV) TXA administration. METHODS We performed a retrospective review of 305 patients with acetabular fractures that underwent open reduction and internal fixation (ORIF). Eighty-nine patients received TXA, and 216 did not. The primary outcome was rates of intraoperative and postoperative allogeneic blood transfusion. RESULTS Baseline demographics and characteristics were similar. Time from injury to surgery and estimated blood loss were comparable. Operative time (p < 0.01) and intraoperative IV fluids (p < 0.01) were greater in the non-TXA group. The proportion of patients who received blood transfusion and mean units transfused intraoperatively and postoperatively did not differ. Mean differences in preoperative and postoperative hemoglobin and hematocrit, hospital length of stay, and perioperative complications also did not differ. In a multivariable regression model, age 60-70 years, Charlson Comorbidity Index, Injury Severity Score, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approaches and intraoperative transfusion requirement were independently associated with postoperative transfusion. CONCLUSION In this study, perioperative IV TXA did not decrease blood loss, need for transfusion, or improve in-hospital outcomes of acetabular fracture surgery. Age 60-70, CCI, ISS, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approach and need for intraoperative transfusion were independently associated with postoperative transfusion. Further prospective trials are warranted to confirm these findings.
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Affiliation(s)
- Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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The efficiency and safety of intravenous tranexamic acid administration in open reduction and internal fixation of pelvic and acetabular fractures. Eur J Trauma Emerg Surg 2021; 48:351-356. [PMID: 33641043 DOI: 10.1007/s00068-021-01624-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to investigate the efficiency and safety of tranexamic acid use in open reduction and internal fixation of pelvis and acetabulum fractures. MATERIALS AND METHODS 73 consecutive patients were included. 1000 mg TXA was administered intravenously to all patients before surgery. The patients were evaluated on the basis of preoperative, postoperative first and third day hemoglobin-hematocrit values, amount of drainage collected, total blood loss, transfusion rates and complications. RESULTS Mean operative time was 120.1 min. Average decrease in hematocrit levels between preoperative and postoperative first day was 2.1 g/dL. Average collected blood from the drain was 177 mL. Mean total blood loss was 1137 mL. Transfusion rate of the patients was 21%. Mean transfused units was 0.9 units. Three patients died within 3 weeks after the operation due to myocardial infarction, acute kidney failure and pneumonia. There were no cases of symptomatic venous or pulmonary thromboembolism during the 90 days of follow-up. CONCLUSION Use of TXA in pelvic and acetabular fractures was found to be effective in reducing total blood loss, hemoglobin drop and transfusion rates without increasing venous and pulmonary thromboembolism in our series.
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