Intravenous injection of tranexamic acid in patients with pelvis or acetabulum fractures to reduce blood loss: a randomized double-blinded controlled trial

Abstract

Background: Despite their low incidence, pelvis and acetabular fractures have a high mortality rate due to extensive hemorrhage. Tranexamic acid (TXA) is an antifibrinolytic drug that inhibits the production of plasminogen. This study aimed to evaluate the safety and efficacy of TXA use to reduce blood loss and the need for blood transfusion in patients with pelvis or acetabulum fractures. Methods: 108 patients were recruited from two tertiary care hospitals, and assigned evenly either to the intervention (TXA) or the control (CTL) group. TXA group received 15mg/kg TXA 30 minutes before the fracture reduction and fixation surgery. The number of transfused blood units before, during, and after the surgery was registered. Blood loss was assessed by calculation of estimated blood loss (EBL), collected blood with drain, collected blood with suction and weight of the used gauzes during the surgery. The time between fracture occurrence and the surgery, the duration of the surgery, and the days of admission were assessed. Results: The mean age was 39.49 ±15.81, 69.4% were female. 6 patients had pelvic and 102 patients had acetabulum fractures. The duration of the surgery was not significantly different. The time gap between fracture occurrence and the surgery was significantly higher in the TXA group (P value=0.032). The mean postoperative hospitalization time was significantly lower among TXA group patients (P value=0.037). The mean hemoglobin was significantly higher in TXA group postoperatively (P value =0.028). The mean EBL, the amount of collected blood volume by suction or drain, the weight of the used gauzes during the surgery and the number of transfused units were significantly lower in the TXA group patients. The transfusion rate was significantly lower in patients with a shorter time gap between fracture occurrence and reduction surgery (P value=0.021) Conclusion: Tranexamic acid can reduce blood loss, the number of transfused blood units during and after the surgery, and hospital admission duration. Moreover, it did not increase the chance of PTE or DVT in the patients receiving tranexamic acid; thus, it can be assumed as a safe and efficient drug in patients with acetabulum or pelvis fractures.

Keywords

• tranexamic acid; pelvis fracture; acetabulum fracture; blood loss