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

Abstract

Background Previous 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 methods This 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. Results Baseline 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. Conclusion To 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 registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-1800017754, retrospectively registered from 2018 to 01-01).

Preoperative Blood Management in Elderly Patients with Delayed Intertrochanteric Fracture Surgery as a Necessary Measure: A Review Data Collection

“…With the popularization of TXA in China, an increasing number of orthopedic surgeons have started using TXA, with satisfactory results in clinical practice. Based on this background, our department con rmed the effectiveness and safety of TXA in IF 11 , complex tibial plateau fractures 20 , femoral shaft nonunion revision surgery 21 , and high tibia osteotomy 22 . However, these studies focused on the effectiveness and safety of intraoperative and postoperative IV use.…”

The efficacy and safety of different does of intravenous tranexamic acid on blood loss in fresh foot and ankle fractures: a prospective, randomized controlled study

“…In arthroscopic surgery, intravenous injection of TXA reduced the postoperative drainage volume after anterior cruciate ligament reconstruction and relieved patients’ pain [ 24 ]. For orthopedic trauma, TXA can reduce hidden blood loss related to intertrochanteric fractures and tibial plateau fractures but does not increase the risk of postoperative venous thromboembolism [ 25 – 27 ]. In spinal surgery, TXA can significantly reduce the total perioperative blood loss volume without obvious side effects [ 28 , 29 ].…”

Tranexamic Acid: When is It Indicated in Orthopaedic Surgery?

“…There have been two RCTs on proximal humeral fractures, and both have demonstrated reduced surgical blood loss in the TXA group, without a difference in complications [36,37]. A RCT on ti-bial fractures [38] found similar results, as did a retrospective study on tibial plateau fractures [39]. There is therefore a high probability of TXA having an effect in any type of major fracture surgery.…”