Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

Abstract

The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA). A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the 2 groups. The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group ( P = .012, P < .01, P < .01, P = .014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group ( P < .01). There were no significant differences in complications between the 2 groups ( P > .05). Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.

Systematic review and meta-analysis of intravenous and topical tranexamic acid in reducing blood loss in knee arthroplasty

“…Also, blood loss from drainage reported in ten analyzed studies indicates an advantage of topical administration (377.9 ± 191.9 vs 302.9 ± 182.6 mL for IV-TXA and T-TXA, respectively). Topical TXA application has the theoretical advantage of limiting systemic toxicity and benefits of locally increased concentrations, and it can potentially avoid the complications of intravenous TXA [51]. Topical intraoperative applications are easy to perform and therefore seem to be practical.…”

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis

“…[10,11] Similar efficacy has been reported in minimally invasive intramedullary nailing for intertrochanteric fractures. [12][13][14] Although topical administration of TXA has only occasionally been reported, some studies have shown that it is safe and effective, [15,16] whereas others have found the contrary. [17,18] The efficacy and safety of topical application are still debatable.…”