Objective

To investigate and compare the efficacy and safety of intravenous and oral application of tranexamic acid (TXA) in geriatric patients undergoing intertrochanteric fracture surgeries.

Methods

All patients with intertrochanteric fracture admitted to the trauma center of the Zhongda hospital were selected after January 1st, 2020. The final patients were divided into three groups. Oral group: 2 ​g oral TXA 2 ​h preoperatively; intravenous group: 15 ​mg/kg intravenous TXA before incision; control group: no intervention. The main outcome measures were blood transfusion rate and total blood loss. Secondary outcomes include intraoperative blood loss, postoperative blood loss, perioperative blood transfusion volumes, length of hospital stay, thromboembolism events and other adverse events.

Results

From January 1, 2020 to December 31, 2020, 124 patients with intertrochanteric fracture were enrolled. According to the inclusion and exclusion criteria, 105 patients were included, including 32 patients in the oral group, 36 patients in the intravenous group and 37 patients in the control group. The demographic characteristics of each group were similar. The blood transfusion rate in the control group was significantly more than that in the experimental group (64.9% vs 40.6% vs 36.1%, P ​= ​0.041). There was no significant difference between the oral group and the intravenous group (P ​= ​0.704). The total blood loss of the oral group and the intravenous group were less than the control group (990.29 ​± ​250.19 ​ml vs 997.47 ​± ​452.34 ​ml vs 1408.54 ​± ​461.74 ​ml), the difference was statistically significant (P ​= ​0.001), and there was no significant difference between the intravenous group and the oral group (P ​= ​0.459). The perioperative blood transfusion volumes of the oral group and the intravenous group were less than the control group (250.00 ​± ​198.62 ​ml vs 227.78 ​± ​179.27 ​ml vs 367.57 ​± ​323.90 ​ml), the difference was statistically significant (P ​= ​0.001), and there was no significant difference between the intravenous group and the oral group (P ​= ​0.832). During hospitalization and follow-up, there were no thromboembolism events such as deep vein thrombosis and pulmonary embolism.

Conclusion

It is safe and effective to use TXA intravenously and orally in elderly patients with intertrochanteric fracture. The results of the two methods are similar in safety and effectiveness. Oral TXA is recommended because of its cost-benefit superiority and its ease of administration.

The translational potential of this article

The result of this prospective cohort study shows that the utilization of oral TXA in elderly patients with intertrochanteric fracture undergoing proximal femur intramedullary nailing possesses great potential in reducing blood loss and cost-benefit superiority.

中文翻译：

---

股骨近端髓内钉治疗老年股骨粗隆间骨折患者口服与静脉注射氨甲环酸：一项前瞻性队列研究

客观的

探讨和比较静脉和口服氨甲环酸（TXA）在老年患者转子间骨折手术中的疗效和安全性。

方法

中大医院创伤中心收治的所有转子间骨折患者均于2020年1月1日以后入选，最终患者分为三组。口服组：术前2 h口服TXA 2 g；静脉组：切口前静脉注射TXA 15mg/kg；对照组：不干预。主要结局指标是输血率和总失血量。次要结局包括术中失血、术后失血、围手术期输血量、住院时间、血栓栓塞事件和其他不良事件。

结果

2020 年 1 月 1 日至 2020 年 12 月 31 日，共纳入 124 例股骨粗隆间骨折患者。根据纳入和排除标准，共纳入105例患者，其中口服组32例，静脉组36例，对照组37例。各组的人口统计学特征相似。对照组输血率明显高于实验组（64.9% vs 40.6% vs 36.1%，P=0.041）。口服组与静脉组比较，差异无统计学意义（P=0.704）。口服组和静脉组总失血量均小于对照组（990.29±250.19ml vs 997.47±452.34ml vs 1408.54±461.74ml），差异有统计学意义（ P = 0.001), 静脉组与口服组比较差异无统计学意义（P=0.459）。口服组和静脉组围手术期输血量均小于对照组（250.00±198.62ml vs 227.78±179.27ml vs 367.57±323.90ml），差异有统计学意义（P = ​0.001），静脉组与口服组无显着差异（P = ​0.832）。住院及随访期间，未发生深静脉血栓、肺栓塞等血栓栓塞事件。57±323.90ml），差异有统计学意义（P=0.001），静脉组与口服组无显着差异（P=0.832）。住院及随访期间，未发生深静脉血栓、肺栓塞等血栓栓塞事件。57±323.90ml），差异有统计学意义（P=0.001），静脉组与口服组无显着差异（P=0.832）。住院及随访期间，未发生深静脉血栓、肺栓塞等血栓栓塞事件。

结论

老年股骨粗隆间骨折患者静脉和口服氨甲环酸是安全有效的。两种方法的结果在安全性和有效性上是相似的。推荐口服 TXA，因为它具有成本效益优势和易于给药的特点。

本文的翻译潜力

这项前瞻性队列研究的结果表明，在股骨近端髓内钉的老年股骨转子间骨折患者中使用口服 TXA 在减少失血和成本效益方面具有巨大潜力。