DOS Kongressen 2014 ·
139
Tranexamic Acid (TA) Reduces Overall Blood Loss
in Unstable Trochanteric Fractures Treated with
Intramedullary Nailing (IMN)
Peter Toft Tengberg, Henrik Palm, Nicolai Foss, Thomas Kallemose, Anders
Troelsen
CORH, Hvidovre Hospital; Anesthesiologic dept, Hvidovre Hospital
Background:
Patients with unstable trochanteric fractures treated with in-
tramedullary nailing (IMN) suffer a major overall blood loss. This is associated
with risk of postoperative anemia resulting in increased morbidity, mortality and
prolonged hospitalization. Tranexamic Acid (TA) has shown documented effect,
with reduced blood loss, in other fields of orthopaedics, such as arthroplasty
surgery.
Purpose / Aim of Study:
The aim of the study was to test if TA can reduce
overall blood loss in patients with unstable trochanteric fractures treated with
a short IMN.
Materials and Methods:
The study is a 2-arm, double blinded, randomized
placebo controlled trial with two groups. The inclusion period was September
2011 to June 2014. Patients with unstable trochanteric fractures scheduled for
a short IMN were eligible for inclusion. Patients in the intervention group were
given a 1 g bolus of TA during initiation of anesthesia and 3 g of TA in 1 l of saline
over 24 hours postoperatively. The placebo group was given a similar regime,
without TA. 270 patients were approached for inclusion. Of these, 75 were in-
cluded, with a final study group of 73 after 2 postoperative inclusions.
Findings / Results:
There were 51 (71%) women. Mean age was 77.3 (SD:
12.3). Mean blood loss in the intervention group (33 patients) was 1410,9 ml
(1001,4) compared to a mean blood loss of 2100,4 (1152,6) in the placebo
group (p=0.008, t-test). There were no cases of in-hospital, thromboembolic
events in either group.
Conclusions:
We found a statistically significant reduction in the overall blood
loss close to 700 mL for patients treated with TA. TA seems to be an effec-
tive blood saving strategy for this group of hip fracture patients and should be
considered in future treatment regimens. Our data revealed no safety concerns.
Further studies should focus on optimal timing and dose of TA.
86.
