THE EFFECTIVENESS OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING OPEN INTRAMEDULLARYNAILING OF DIAPHYSEAL FEMORAL FRACTURES INSTITUTIONS
Background and Objectives: Tranexamic acid (TA) is an antifibrinolytic agent that prevents clot lysis. It has been used to reduce peri-operative blood loss in arthroplasty and spine surgeries. Its effectiveness in other orthopaedic surgeries, including open intramedullary nailing for femoral diaphyseal fractures, with regard to reduction in blood loss and associated thrombotic risks, has not been adequately studied.
Methods: Eighty patients with isolated femoral diaphyseal fractures treated with Surgical Implant Generation Network (SIGN) intramedullary nails were randomized into two equal groups. One group received tranexamic acid (TA) while the other received 100 mL of normal saline (NS). Pre-operative and post-operative haematocrit levels on days 1 and 5 were recorded and calculated blood loss (CBL) was determined. Thrombotic risk was assessed using serial fluorescent immunosorbent assay for quantitative D-dimer monitoring.
Results: The CBL was significantly lower in the TA group compared to the NS group (TA 0.44 ± 0.166; NS 0.57 ± 0.21, p = 0.004). A significantly lower reduction in mean haematocrit level on day 5 and a shorter hospital stay favoured the TA group. Transfusion rate was not significantly different between the TA and NS groups (TA 0.95 ± 0.78; NS 1.22 ± 0.80, p = 0.124). No significant difference in serum D-dimer values was observed after tranexamic acid administration compared to the control. However, the rate of decline to baseline was significantly faster in the normal saline group compared to the TA group at week 2.
Conclusion: Tranexamic acid reduces calculated peri-operative blood loss in the fixation of femoral fractures using an open intramedullary nailing technique. This volume reduction, however, does not impact the number of pints transfused. The effect of tranexamic acid on thrombosis, monitored using D-dimer, is prolonged in the post-operative period. Tranexamic acid use significantly reduces hospital stay, encourages early ambulation, and maintains a higher post-operative packed cell volume.