Xinxian XU, Linghui XİE, Huachen YU, Yuezheng HU

Safety and efficacy of tranexamic acid with epinephrine for prevention of blood loss following surgery for trochanteric femoral fractures

Objective: This study aimed to determine whether the local administration of tranexamic acid (TXA) combined with diluted epinephrine (DEP) reduces blood loss and the need for transfusions compared with the administration of TXA alone following surgery for trochanteric femoral fractures. Methods: Hundred patients were enrolled in this study. In the target group (TXA/DEP group: n=50; 19 men and 31 women, mean age 72.5±11.1 years), the surgical sites were injected with 35 mL normal saline mixed with 3 g of TXA with 0.2 mg of DEP at a 1:200,000 dilution (TXA/DEP) immediately after musculoaponeurotic closure. In the control group (TXA group: n=50; 22 men and 28 women; mean age: 70.5±12.2 years), the surgical site was injected with 35 mL normal saline containing 3 g of TXA alone. The main outcome measures were postoperative hemoglobin (Hb) levels, hematocrit, drainage volume, and total blood loss (TBL); the secondary measures included transfusion requirements and perioperative complications. Results: The mean Hb levels among patients in theTXA/DEP group were significantly lower than among those in the TXA group, measured on postoperative day 1 at 101.0±14.1 g/L vs. 106.9±10.5 g/L and day 3 as 104.2±8.2 g/L vs. 108.5±9.1 g/L, respectively (p

___

1. Díaz AR, Navas PZ. Risk factors for trochanteric and femoral neck fracture. Rev Esp Cir Ortop Traumatol 2018; 62: 134-41. [CrossRef]

2. Zuckerman JD, Koval KJ, Aharonoff GB, Hiebert R, Skovron ML. A functional recovery score for elderly hip fracture patients: I. development. J Orthop Trauma 2000; 14: 20-5. [CrossRef]

3. Yousry AH, Chotai PN, El Ghazaly SA, Fayyad TA, Abdelgawad AA. Outcomes of trochanteric external fixation for geriatric inter-trochanteric hip fractures. J Orthop 2015; 12: 174-8. [CrossRef]

4. Ronga M, Bonzini D, Valoroso M, et al. Blood loss in trochanteric fractures: Multivariate analysis comparing dynamic hip screw and Gamma nail. Injury 2017; 48: 44-7. [CrossRef]

5. Gulabi D, Yuce Y, Erkal KH, Saglam N, Camur S. The combined administration of systemic and topical tranexamic acid for total hip arthroplasty: Is it better than systemic? Acta Orthop Traumatol Turc 2019; 53: 297-300. [CrossRef]

6. Kashyap S, Mahajan S, Lal M. Effects of topical tranexamic acid during open reduction and internal fixation of acetabular fractures: A retrospective study. Acta Orthop Traumatol Turc 2019; 53: 175- 9. [CrossRef]

7. Zhu Q, Yu C, Chen X, et al. Efficacy and safety of tranexamic acid for blood salvage in intertrochanteric fracture surgery: A meta-analysis. Clin Appl Thromb Hemost 2018; 24: 1189-98. [CrossRef]

8. Gao F, Sun W, Guo W, Li Z, Wang W, Cheng L. Topical application of tranexamic acid plus diluted epinephrine reduces postoperative hidden blood loss in total hip arthroplasty. J Arthroplasty 2015; 30: 2196-200. [CrossRef]

9. Malone KJ, Matuszak S, Mayo D, Greene P. The effect of intra-articular epinephrine lavage on blood loss following total knee arthroplasty. Orthopedics 2009; 32: 100.

10. Wu Y, Zeng Y, Bao X, Xiong H, Fan X, Shen B. Application of tranexamic acid and diluted epinephrine in primary total hip arthroplasty. Blood Coagul Fibrinolysis 2018; 29: 451-7. [CrossRef]

11. Kuo LT, Chen CL, Yu PA, Hsu WH, Chi CC, Yoo JC. Epinephrine in irrigation fluid for visual clarity in arthroscopic shoulder surgery: A systematic review and meta-analysis. Int Orthop 2018; 42: 2881-9. [CrossRef]

12. Von Känel R, Dimsdale JE. Effects of sympathetic activation by adrenergic infusions on hemostasis in vivo. Eur J Haematol 2000; 65: 357-69. [CrossRef]

13. Jans Ø, Grevstad U, Mandøe H, Kehlet H, Johansson PI. A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty. Br J Anaesth 2016; 116: 357-62. [CrossRef]

14. Li AB, Zhang WJ, Wang JQ, Zhao YM, Guo WJ. Learning curve and clinical outcomes of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures. Biomed Res Int 2017; 2017. [CrossRef]

15. Gross JB. Estimating allowable blood loss: Corrected for dilution. Anesthesiology 1983; 58: 277-80. [CrossRef]

16. McCormack PL. Tranexamic acid. Drugs 2012; 72: 585-617. [CrossRef]

17. Drakos A, Raoulis V, Karatzios K, et al. Efficacy of local administration of tranexamic acid for blood salvage in patients undergoing intertrochanteric fracture surgery. J Orthop Trauma 2016; 30: 409- 14. [CrossRef]

18. Zhao Z, Ma X, Ma J, Sun X, Li F, Lv J. A systematic review and meta-analysis of the topical administration of fibrin sealant in total hip arthroplasty. Sci Rep 2018; 8: 78. [CrossRef]

19. Li ZJ, Fu X, Xing D, Zhang HF, Zang JC, Ma XL. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J 2013; 22: 1950-7. [CrossRef]

20. Aytuluk HG, Yaka HO. Tranexamic acid is effective in lower doses with infusion in total knee arthroplasty. Acta Orthop Traumatol Turc 2019; 53: 81-5. [CrossRef]

21. Gao F, Sun W, Guo W, Li Z, Wang W, Cheng L. Topical administration of tranexamic acid plus diluted-epinephrine in primary total knee arthroplasty: A randomized double-blinded controlled trial. J Arthroplasty 2015; 30: 1354-8. [CrossRef]