ǂThe ǂEffect of tranexamic acid on the reduction of intraoperative and postoperative blood loss and thromboembolic risk in patients with hip fracture

[I. B. Stojadinović]

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UVOD: Veliki problem kod pacijenata nakon operacije preloma kuka predstavlja krvarenje. Kao način rešavanja tih problema, sve više se uvodi upotreba traneksamične kiseline. Cilj ove studije je utvrditi da li primena traneksamične kiseline kod ovih pacijenata utiče na smanjenje intraoperativnog i postoperativnog krvarenja, a sa druge strane, da li povećava rizik od tromboembolijskih komplikacija. METOD: Urađena je prospektivna randomizirana klinička studija. Ispitivali su se pacijenti sa prelomom kuka, lečeni u Klinici za ortopediju i traumatologiju Univerzitetskog Kliničkog Centra Kragujevac, u jednogodišnjem periodu. Pacijenti su podeljeni u dve grupe (1:1), jedna kojoj se davala traneksamična kiselina, druga kojoj se davao placebo. Traneksamična kiselina se davala u dve doze. Prva od 15mg/kg telesne težine, neposredno pre, a druga, u istoj dozi, tri sata nakon operacije. Preoperativno i postoperativno su merene vrednosti hemoglobina, hematokrita, eritrocita i krvnog pritiska. Merena je količina aspirirane krvi za vreme operacije i drenirane u postoperativnom periodu od 24 časa. Praćena je pojava DVT ultrazvukom donjih ekstremiteta. REZULTATI: Prosečna količina aspirirane krvi kod pacijenata koji su primili traneksamičnu kiselinu iznosila je 133±32,1ml, naspram 305,8±60,3ml kod pacijenata koji nisu. Prosečna količina drenirane krvi kod pacijenata koji su primili traneksamičnu kiselinu iznosila je 147,2±51,5ml, naspram 346,8±100,1ml kod pacijenata koji nisu. Količina ukupne izgubljene krvi 3 puta je manja kod pacijenata koji su primili traneksamičnu kiselinu (135,1±144,6ml krvi naspram 344,1±147,3ml krvi). Među pacijentima koji su razvili tromboembolijske komplikacije njih 2 (66,7%) primilo je preoperativno traneksamičnu kiselinu, a 1 (33,3%) nije. ZAKLjUČAK: Primena traneksamične kiseline kod pacijenata sa prelomom kuka značajno smanjuje intraoperativno i postoperativno krvarenje, bez značajnijeg rizika za pojavu tromboembolijskih komplikacija.

INTRODUCTION: A major problem in patients after hip fracture surgery is bleeding. As a way to solve these problems, the use of tranexamic acid is increasingly introduced. The aim of this study is to determine whether the use of tranexamic acid in these patients reduces intraoperative and postoperative bleeding, and on the other hand, whether it increases the risk of thromboembolic complications. METHOD: A prospective randomized clinical study was performed. Patients with hip fractures, treated at the Clinic for Orthopedics and Traumatology of the University Clinical Center Kragujevac, were examined over a one-year period. Patients were divided into two groups (1:1), one receiving tranexamic acid, the other receiving placebo. Tranexamic acid was administered in two doses. The first of 15 mg/kg of body weight, immediately before, and the second, in the same dose, three hours after the operation. Hemoglobin, hematocrit, erythrocytes and blood pressure values were measured preoperatively and postoperatively. The amount of blood aspirated during surgery and drained in the postoperative period of 24 hours was measured. The occurrence of DVT was followed by ultrasound of the lower extremities. RESULTS: The average amount of aspirated blood in patients who received tranexamic acid was 133±32.1ml, versus 305.8±60.3ml in patients who did not. The average amount of drained blood in patients who received tranexamic acid was 147.2±51.5ml, compared to 346.8±100.1ml in patients who did not. The amount of total blood lost was 3 times lower in patients who received tranexamic acid (135.1±144.6ml of blood versus 344.1±147.3ml of blood). Among the patients who developed thromboembolic complications, 2 (66.7%) received tranexamic acid preoperatively, and 1 (33.3%) did not. CONCLUSION: The use of tranexamic acid in patients with hip fracture significantly reduces intraoperative and postoperative bleeding, without significant risk of thromboembolic complications

traneksamična kiselina, prelom kuka, krvarenje, tromboembolija

tranexamic acid, hip fracture, bleeding, thromboembolism

616.728.2-001.5-089:616.14-005.1/.6(043.3)

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