Comparative Use of Tranexamic Acid Intravenous and Topical Application in Intertrochanteric Fractures With PFNA
Status:
Recruiting
Trial end date:
2022-12-18
Target enrollment:
Participant gender:
Summary
An intertrochanteric (ITF) trochanteric fracture of the femur is an exclusively extra
capsular fracture in which the fracture line extends from the greater trochanter to the
lesser trochanter. Its incidence has increased significantly over the past decades and is
expected to double in the next 25 years, with an important global economic impact . It
affects women in the seventh and eighth decades of life, an age group older than femoral neck
fractures. For this reason, the mortality of intertrochanteric fractures is twice that of the
femoral neck.
The treatment is surgical, in which the objective is the stable internal fixation and the
patient's early ambulation.
Functional outcomes and treatment mortality are related including factors perioperative
anemia and blood loss.Even so, even with these precautions, blood loss in this surgical
procedure appears to be greater than expected, with blood loss of the order of 2100ml.
Blood loss management and the inherent risks of anemia can be circumvented with blood
transfusion. However, blood transfusion is not without risks and complications, such as
hypersensitivity and hemolytic reactions, cardiac overload, infectious diseases. Homologous
transfusions are associated with prolonged hospital stay, increased costs and increased
patient morbidity and mortality.
So, alternatives have been used to avoid the use of blood such as saline solutions, use of
erythropoietin and antifibrinolytic agents . Tranexamic acid (TXA) is a drug that interferes
with fibrinolysis, in use for more than 50 years in surgery, particularly in cardiac surgery.
Only recently, TXA has sparked interest in orthopedic surgeries. Studies have shown the
effectiveness and safety of TXA at FIT, but presented different forms of administration
(intravenous, topical, infiltrative) . Despite promising results to contain bleeding in
elective orthopedic surgery and fractures, in daily practice, TXA is not very popular,
especially in fractures, and has not been used routinely by all doctors. Studies have not
been found in the literature about the topical use of TXA compared to intravenous use in FIT.