Research progress on tranexamic acid in traumatic orthopedic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Shaoyun ¹ , XIAO Cong ¹ ,  PEI Fuxing ²

1. Department of Orthopedics, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang Sichuan, 621000, P.R.China;
2. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

PEI Fuxing, Email: peifuxinghx@163.com

Keywords：

Tranexamic acid; traumatic orthopedic surgery; hip fracture

DOI：

10.7507/1002-1892.201902030

Video：

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Objective To summarize the research progress on the application of tranexamic acid (TXA) in traumatic orthopedic surgery in recent years.Methods The domestic and foreign literature in recent years was reviewed, and the efficacy and safety of TXA in traumatic orthopedic surgeries with different regimen, dose and route of administration were comprehensively summarized and compared.Results The application of TXA in traumatic orthopedic surgeries increased gradually in recent years. Intravenous or topical administration of TXA efficaciously reduced blood loss and transfusion requirements during hip fracture surgery without significantly increasing the risk of thromboembolic events. However, the efficacy was not clear in other traumatic orthopedic surgeries such as pelvic and acetabular fractures.Conclusion More studies are needed to confirm the efficacy and safety of TXA in traumatic orthopedic surgeries.

Citation： ZHANG Shaoyun, XIAO Cong, PEI Fuxing. Research progress on tranexamic acid in traumatic orthopedic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1457-1461. doi: 10.7507/1002-1892.201902030 Copy

1.	Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth, 2004, 93(6): 842-858.
2.	Fillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty, 2018, 33(10): 3065-3069.
3.	Gianakos AL, Hurley ET, Haring RS, et al. Reduction of blood loss by tranexamic acid following total hip and knee arthroplasty: a Meta-analysis. JBJS Rev, 2018, 6(5): e1.
4.	Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct Meta-analysis. J Arthroplasty, 2018, 33(10): 3070-3082.
5.	Gausden EB, Qudsi R, Boone MD, et al. Tranexamic acid in orthopaedic trauma surgery: a Meta-analysis. J Orthop Trauma, 2017, 31(10): 513-519.
6.	Chen W, Lv H, Liu S, et al. National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health, 2017, 5(8): e807-e817.
7.	Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing, 2008, 37(2): 173-178.
8.	Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology, 2010, 113(2): 482-495.
9.	Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
10.	Lee C, Freeman R, Edmondson M, et al. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury, 2015, 46(10): 1978-1982.
11.	Liu W, Hui H, Zhang Y, et al. Intra-articular tranexamic acid injection during the hip hemi-arthroplasty in elderly patients: a retrospective study. Geriatr Orthop Surg Rehabil, 2018, 9: 2151459318803851.
12.	Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res, 2014, 8(1): 48-53.
13.	Watts CD, Houdek MT, Sems SA, et al. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: a randomized clinical trial. J Orthop Trauma, 2017, 31(7): 345-351.
14.	朱前拯, 于彩霞, 陈星佐, 等. 氨甲环酸对人工关节置换术治疗老年股骨颈骨折围手术期失血的影响. 中华创伤骨科杂志, 2018, 20(7): 623-626.
15.	Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124.
16.	金志超, 郑晓辉, 余翔, 等. 氨甲环酸降低转子间骨折围术期失血的有效性及安全性. 中国组织工程研究, 2018, 22(15): 2361-2366.
17.	朱芸, 赵刚, 李思宁, 等. 氨甲环酸对老年股骨粗隆间骨折患者行PFNA内固定手术围术期失血的有效性及安全性研究. 重庆医学, 2017, 46(20): 2797-2799.
18.	雷金来, 丛雨轩, 庄岩, 等. 术前应用氨甲环酸对股骨近端防旋髓内钉固定治疗股骨转子间骨折隐性失血的影响. 中华创伤骨科杂志, 2017, 19(2): 103-108.
19.	Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hong Kong), 2016, 24(3): 379-382.
20.	Mohib Y, Rashid RH, Ali M, et al. Does tranexamic acid reduce blood transfusion following surgery for inter-trochanteric fracture? A randomized control trial J Pak Med Assoc, 2015, 65(11 Suppl 3): S17-S20.
21.	Tian S, Shen Z, Liu Y, et al. The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA. Injury, 2018, 49(3): 680-684.
22.	Tengberg PT, Foss NB, Palm H, et al. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial. Bone Joint J, 2016, 98-B(6): 747-753.
23.	胡定, 罗刚, 倪卫东. 术后静脉滴注氨甲环酸对股骨近端防旋髓内钉治疗老年股骨转子间骨折围术期失血量的影响. 中华创伤杂志, 2018, 34(5): 410-414.
24.	张连方, 朱锋, 周军, 等. 氨甲环酸减少股骨粗隆间骨折PFNA围术期失血. 中国矫形外科杂志, 2017, 25(24): 2248-2250.
25.	Schiavone A, Bisaccia M, Inkov I, et al. Tranexamic acid in pertrochanteric femoral fracture: is it a safe drug or not? Folia Med (Plovdiv), 2018, 60(1): 67-78.
26.	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(8): 409-414.
27.	Virani SR, Dahapute AA, Panda I, et al. Role of local infiltration of tranexamic acid in reducing blood loss in peritrochanteric fracture surgery in the elderly population. Malays Orthop J, 2016, 10(3): 26-30.
28.	林锦秀, 孙东升, 郑潇, 等. 局部应用氨甲环酸干预股骨粗隆间骨折PFNA内固定术后隐性失血的临床分析. 山东大学学报 (医学版), 2016, 54(1): 67-70.
29.	史庆轩, 梁晓松, 李昊, 等. 局部应用氨甲环酸和止血纱布减少股骨粗隆间骨折手术失血. 中国矫形外科杂志, 2018, 26(4): 315-319.
30.	Pohlemann T, Tscherne H, Baumgärtel F, et al. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg, 1996, 99(3): 160-167.
31.	Raobaikady R, Redman J, Ball JA, et al. Use of activated recombinant coagulation factor VII in patients undergoing reconstruction surgery for traumatic fracture of pelvis or pelvis and acetabulum: a double-blind, randomized, placebo-controlled trial. Br J Anaesth, 2005, 94(5): 586-591.
32.	Odak S, Raza A, Shah N, et al. Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery. Ann R Coll Surg Engl, 2013, 95(5): 357-360.
33.	Magnussen RA, Tressler MA, Obremskey WT, et al. Predicting blood loss in isolated pelvic and acetabular high-energy trauma. J Orthop Trauma, 2007, 21(9): 603-607.
34.	Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
35.	Piggott RP, Leonard M. Is there a role for antifibrinolytics in pelvic and acetabular fracture surgery? Ir J Med Sci, 2016, 185(1): 29-34.
36.	Xie B, Tian J, Zhou DP. Administration of tranexamic acid reduces postoperative blood loss in calcaneal fractures: a randomized controlled trial. J Foot Ankle Surg, 2015, 54(6): 1106-1110.
37.	张玉富, 李国珅, 查晔军, 等. 氨甲环酸对减少肘关节僵硬松解术后出血的临床效果分析. 山东医药, 2015, 55(28): 80-81.
38.	Brohi K, Cohen MJ, Ganter MT, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma, 2008, 64(5): 1211-1217.
39.	CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011, 377(9771): 1096-1101.
40.	Monsef Kasmaei V, Javadi A, Naseri Alavi SA. Effects of tranexamic acid on reducing blood loss in pelvic trauma: A randomised double-blind placebo controlled study. J Clin Orthop Trauma, 2019, 10(2): 286-289.
41.	Wu JZ, Liu PC, Ge W, et al. A prospective study about the preoperative total blood loss in older people with hip fracture. Clin Interv Aging, 2016, 11: 1539-1543.
42.	Mannucci PM. Hemostatic drugs. N Engl J Med, 1998, 339(4): 245-253.
43.	Geerts WH, Code KI, Jay RM, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med, 1994, 331(24): 1601-1606.
44.	谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
45.	张少云, 曹国瑞, 黄强, 等. 影响人工全膝关节置换术后血清IL-6水平的危险因素分析. 中国修复重建外科杂志, 2018, 32(8): 1001-1005.

1. Mahdy AM, Webster NR. Perioperative systemic haemostatic agents. Br J Anaesth, 2004, 93(6): 842-858.
2. Fillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty, 2018, 33(10): 3065-3069.
3. Gianakos AL, Hurley ET, Haring RS, et al. Reduction of blood loss by tranexamic acid following total hip and knee arthroplasty: a Meta-analysis. JBJS Rev, 2018, 6(5): e1.
4. Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct Meta-analysis. J Arthroplasty, 2018, 33(10): 3070-3082.
5. Gausden EB, Qudsi R, Boone MD, et al. Tranexamic acid in orthopaedic trauma surgery: a Meta-analysis. J Orthop Trauma, 2017, 31(10): 513-519.
6. Chen W, Lv H, Liu S, et al. National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals. Lancet Glob Health, 2017, 5(8): e807-e817.
7. Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing, 2008, 37(2): 173-178.
8. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology, 2010, 113(2): 482-495.
9. Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
10. Lee C, Freeman R, Edmondson M, et al. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury, 2015, 46(10): 1978-1982.
11. Liu W, Hui H, Zhang Y, et al. Intra-articular tranexamic acid injection during the hip hemi-arthroplasty in elderly patients: a retrospective study. Geriatr Orthop Surg Rehabil, 2018, 9: 2151459318803851.
12. Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res, 2014, 8(1): 48-53.
13. Watts CD, Houdek MT, Sems SA, et al. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: a randomized clinical trial. J Orthop Trauma, 2017, 31(7): 345-351.
14. 朱前拯, 于彩霞, 陈星佐, 等. 氨甲环酸对人工关节置换术治疗老年股骨颈骨折围手术期失血的影响. 中华创伤骨科杂志, 2018, 20(7): 623-626.
15. Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124.
16. 金志超, 郑晓辉, 余翔, 等. 氨甲环酸降低转子间骨折围术期失血的有效性及安全性. 中国组织工程研究, 2018, 22(15): 2361-2366.
17. 朱芸, 赵刚, 李思宁, 等. 氨甲环酸对老年股骨粗隆间骨折患者行PFNA内固定手术围术期失血的有效性及安全性研究. 重庆医学, 2017, 46(20): 2797-2799.
18. 雷金来, 丛雨轩, 庄岩, 等. 术前应用氨甲环酸对股骨近端防旋髓内钉固定治疗股骨转子间骨折隐性失血的影响. 中华创伤骨科杂志, 2017, 19(2): 103-108.
19. Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hong Kong), 2016, 24(3): 379-382.
20. Mohib Y, Rashid RH, Ali M, et al. Does tranexamic acid reduce blood transfusion following surgery for inter-trochanteric fracture? A randomized control trial J Pak Med Assoc, 2015, 65(11 Suppl 3): S17-S20.
21. Tian S, Shen Z, Liu Y, et al. The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA. Injury, 2018, 49(3): 680-684.
22. Tengberg PT, Foss NB, Palm H, et al. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial. Bone Joint J, 2016, 98-B(6): 747-753.
23. 胡定, 罗刚, 倪卫东. 术后静脉滴注氨甲环酸对股骨近端防旋髓内钉治疗老年股骨转子间骨折围术期失血量的影响. 中华创伤杂志, 2018, 34(5): 410-414.
24. 张连方, 朱锋, 周军, 等. 氨甲环酸减少股骨粗隆间骨折PFNA围术期失血. 中国矫形外科杂志, 2017, 25(24): 2248-2250.
25. Schiavone A, Bisaccia M, Inkov I, et al. Tranexamic acid in pertrochanteric femoral fracture: is it a safe drug or not? Folia Med (Plovdiv), 2018, 60(1): 67-78.
26. 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(8): 409-414.
27. Virani SR, Dahapute AA, Panda I, et al. Role of local infiltration of tranexamic acid in reducing blood loss in peritrochanteric fracture surgery in the elderly population. Malays Orthop J, 2016, 10(3): 26-30.
28. 林锦秀, 孙东升, 郑潇, 等. 局部应用氨甲环酸干预股骨粗隆间骨折PFNA内固定术后隐性失血的临床分析. 山东大学学报 (医学版), 2016, 54(1): 67-70.
29. 史庆轩, 梁晓松, 李昊, 等. 局部应用氨甲环酸和止血纱布减少股骨粗隆间骨折手术失血. 中国矫形外科杂志, 2018, 26(4): 315-319.
30. Pohlemann T, Tscherne H, Baumgärtel F, et al. Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg, 1996, 99(3): 160-167.
31. Raobaikady R, Redman J, Ball JA, et al. Use of activated recombinant coagulation factor VII in patients undergoing reconstruction surgery for traumatic fracture of pelvis or pelvis and acetabulum: a double-blind, randomized, placebo-controlled trial. Br J Anaesth, 2005, 94(5): 586-591.
32. Odak S, Raza A, Shah N, et al. Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery. Ann R Coll Surg Engl, 2013, 95(5): 357-360.
33. Magnussen RA, Tressler MA, Obremskey WT, et al. Predicting blood loss in isolated pelvic and acetabular high-energy trauma. J Orthop Trauma, 2007, 21(9): 603-607.
34. Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
35. Piggott RP, Leonard M. Is there a role for antifibrinolytics in pelvic and acetabular fracture surgery? Ir J Med Sci, 2016, 185(1): 29-34.
36. Xie B, Tian J, Zhou DP. Administration of tranexamic acid reduces postoperative blood loss in calcaneal fractures: a randomized controlled trial. J Foot Ankle Surg, 2015, 54(6): 1106-1110.
37. 张玉富, 李国珅, 查晔军, 等. 氨甲环酸对减少肘关节僵硬松解术后出血的临床效果分析. 山东医药, 2015, 55(28): 80-81.
38. Brohi K, Cohen MJ, Ganter MT, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma, 2008, 64(5): 1211-1217.
39. CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet, 2011, 377(9771): 1096-1101.
40. Monsef Kasmaei V, Javadi A, Naseri Alavi SA. Effects of tranexamic acid on reducing blood loss in pelvic trauma: A randomised double-blind placebo controlled study. J Clin Orthop Trauma, 2019, 10(2): 286-289.
41. Wu JZ, Liu PC, Ge W, et al. A prospective study about the preoperative total blood loss in older people with hip fracture. Clin Interv Aging, 2016, 11: 1539-1543.
42. Mannucci PM. Hemostatic drugs. N Engl J Med, 1998, 339(4): 245-253.
43. Geerts WH, Code KI, Jay RM, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med, 1994, 331(24): 1601-1606.
44. 谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
45. 张少云, 曹国瑞, 黄强, 等. 影响人工全膝关节置换术后血清IL-6水平的危险因素分析. 中国修复重建外科杂志, 2018, 32(8): 1001-1005.

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