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Abstract：
BACKGROUND This prospective study from a single center aimed to compare the perioperative blood loss (PBL) in 79 patients with intertrochanteric fractures (IF) treated with intramedullary nailing (IMN) using 3 regimens of combined tranexamic acid (TXA) and low molecular weight heparin (LMWH), proposing a novel therapy of 4-dose TXA. MATERIAL AND METHODS We recruited 79 patients and randomly divided them into 3 groups. The 4-dose TXA group (22 patients) received 1.0 g intravenous TXA 30 min before surgery and 1.0 g at intervals of 3, 6, and 9 h before surgery. The 1-dose TXA group (25 patients) received 1.0 g intravenous TXA 30 min before surgery, while the control group (32 patients) did not receive TXA. LMWH was applied 12 h after surgery in each group. The primary metrics evaluated included hidden blood loss (HBL), total blood loss (TBL), and the number and incidence rate of deep vein thrombosis (DVT). RESULTS Analysis of the HBL revealed that the 4-dose TXA group had the lowest average (583.13±318.08 ml), followed by the 1-dose TXA group (902.94±509.99 ml), and the control group showed the highest (1154.39±452.06 ml) (P<0.05). A similar result was observed for TBL (4-dose group: 640.86±337.22 ml, 1-dose group: 971.74±511.14 ml, control group: 1226.27±458.22 ml, P<0.05). Regarding DVT, the 4-dose TXA group had 5 cases (incidence rate 22.73%), the 1-dose TXA group had 6 cases (incidence rate 24.00%), and the control group had 8 cases (incidence rate 25.00%), with no significant difference among groups (P>0.05). CONCLUSIONS Treatment using 4-dose TXA and LMWH can effectively reduce PBL without increasing the DVT risk in IF patients with IMN.
摘要：
背景这项来自单中心的前瞻性研究旨在比较79例股骨转子间骨折（IF）患者的围手术期失血量（PBL），这些患者采用3种氨甲环酸（TXA）和低分子肝素（LMWH）联合髓内钉（IMN）治疗，提出了一种4剂量TXA的新疗法。材料与方法我们招募了79例患者，随机分为3组。4剂量TXA组（22例）在手术前30分钟接受1.0g静脉TXA，在手术前3、6和9小时间隔接受1.0gTXA。1剂量TXA组（25例）在手术前30分钟静脉注射1.0gTXA，而对照组(32例)未接受TXA。各组术后12h应用LMWH。评估的主要指标包括隐性失血(HBL)，总失血量（TBL），深静脉血栓形成(DVT)的数量和发生率。结果HBL分析表明，4剂量TXA组的平均值最低（583.13±318.08ml），其次是1剂量TXA组（902.94±509.99ml），对照组最高(1154.39±452.06ml)(P<0.05)。对于TBL观察到类似的结果（4剂量组：640.86±337.22ml，1剂量组：971.74±511.14ml，对照组:1226.27±458.22ml,P<0.05)。关于DVT,4剂量TXA组5例(发生率22.73%),1剂TXA组有6例（发生率24.00%），对照组8例(发生率25.00%),组间差异无统计学意义(P>0.05)。结论4剂量TXA和LMWH治疗可有效降低INIF患者PBL，且不增加DVT风险。
