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Efficacy of Local Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing Intertrochanteric Fracture Surgery

Drakos, Athanasios MD; Raoulis, Vasilios MD; Karatzios, Konstantinos MD; Doxariotis, Nikolaos MD; Kontogeorgakos, Vasilios MD; Malizos, Konstantinos MD; Varitimidis, Sokratis E. MD

doi: 10.1097/BOT.0000000000000577
Original Article

Objectives: The primary aim of this study was to assess whether local administration of tranexamic acid (TXA) reduced the need for a blood transfusion in elderly patients treated with an intramedullary (IM) nail for an intertrochanteric fracture.

Design: Randomized prospective trial.

Setting: Academic level 1 trauma center.

Patients: Two hundred patients (200 fractures) over 65 years with an intertrochanteric fracture treated by IM nail between April 1, 2012, and March 31, 2014.

Intervention: Subfascial administration of 3 g of TXA around the fracture site at the end of the surgical procedure, versus a control group without TXA. Follow-up ranged from 12 to 24 months.

Main Outcome Measures: Group differences in number of transfused packed red blood cell (PRBC) units, and hematocrit, hemoglobin, and platelet count.

Results: There was a 43% reduction in transfusion requirements in the TXA group (P < 0.01). Twenty-seven units of PRBC were transfused in 22/100 patients in the TXA group, whereas 48 PRBC units were transfused in 29/100 patients in control group. There was no difference between the 2 groups in terms of late complications and overall mortality rate.

Conclusions: Subfascial administration of TXA around the fracture site in elderly patients undergoing IM nailing for intertrochanteric fractures is safe and cost-effective. A significant reduction in blood loss and transfused blood units, and health care cost can be achieved.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece; and

Department of Orthopaedics, Attikon University Hospital, Athens, Greece.

Reprints: Sokratis E. Varitimidis, MD, Department of Orthopaedic Surgery, University of Thessaly, Medical School Biopolis, Larissa 41110, Greece (e-mail: svaritimidis@ortho-uth.org).

Presented in part as a free oral presentation at the 16th EFORT Congress, May 27, 2015, Prague, Czech Republic.

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Accepted March 03, 2016

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