Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Abstract

Background:<br />Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to<br />postoperative acute anemia and some other complications.<br />Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion<br />requirements during some elective surgeries (1-3).<br />The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a<br />subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.<br />Methods:<br />Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary<br />nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group<br />I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision.<br />Patients in the placebo group received an identical volume of normal saline.<br />Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin<br />change as well as transfusion rates and volumes were compared between the two groups.<br />Results:<br />Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups,<br />respectively (<br />P=0.570<br />). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group<br />(5.6%) compared to the placebo group (30%) (<br />P=0.06<br />). No significant difference in The Allowable Blood Loss during the<br />surgery was found between the two groups (<br />P=0.894<br />).<br />Conclusion:<br />Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during<br />traumatic femoral fracture operation.