Effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.