Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

BMC Musculoskeletal Disorders

Cheng Ren¹  Kun Zhang¹  Zhong Li¹  Jiarui Yang¹  Teng Ma¹  Qian Wang¹  Zhimeng Wang²  Yao Lu³  Bing Zhang⁴  Leilei Song⁵ 

[1] Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, No. 555, East Youyi Road, 710000, Xi’an, Shaanxi, China;Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, No. 555, East Youyi Road, 710000, Xi’an, Shaanxi, China;Department of Orthopaedics and Trauma, The Second Affiliated Hospital of Xi’an Medical College, No. 167, East Textile Road, 710000, Xi’an, Shaanxi, China;Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, No. 555, East Youyi Road, 710000, Xi’an, Shaanxi, China;The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi’an Jiaotong University, 710049, Xi’an, People’s Republic of China;Bioinspired Engineering and Biomechanics Center (BEBC), Xi’an Jiaotong University, 710049, Xi’an, China;Department of Orthopaedics and Trauma, The Second Affiliated Hospital of Xi’an Medical College, No. 167, East Textile Road, 710000, Xi’an, Shaanxi, China;Qinghai University, 810000, Xi’ning, Qinghai, China;

关键词: Tranexamic acid;    Hyperfibrinolysis;    Tibial plateau fracture;   

DOI  :  10.1186/s12891-020-03772-7

来源: Springer

【 摘 要 】

BackgroundPrevious studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.Material and methodsThis was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.ResultsBaseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P<0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P<0.05), 2.8 vs 3.3 (POD4, P<0.05), and 2.1 vs. 2.6 (PO6W, P<0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.ConclusionTo our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-1800017754, retrospectively registered from 2018 to 01-01).

【 授权许可】

CC BY