Effect Of Tranexamic Acid Combined With Autologous Blood Transfusion On Blood Loss In Patients Of Femoral Neck Fracture Underwent Total Hip Arthroplasty

Objective: To investigate the effect and safety of tranexamic acid combined with autologous blood transfusion on blood loss in elderly patients of femoral neck fractures underwent unilateral total hip arthroplasty.Methods: From February 2018 to October 2019,elderly patients diagnosed with FNF and underwent unilateral THA in the orthopedics area of Xiangtan Central Hospital were selected as the research subjects.They were divided into three groups according to random number method: A total of 87 patients were included according to the exclusion criteria,including group A(TXA combined with ABT test group n = 30 cases),group B(TXA control group n = 28 cases),and group C(ABT control group n = 29 cases).Group A: 15 mg / kg TXA was dissolved in 100 ml of normal saline for intravenous infusion 15 minutes before skin incision,2 g(20 ml)of TXA stock solution was injected into the local joint cavity after closing the incision,and combined with ABT.Group B: 15 mg / kg TXA was dissolved in 100 ml of normal saline for intravenous infusion 15 minutes before skin incision,2 g(20 ml)of TXA stock solution was injected into the local articular cavity after closing the incision,without combining ABT.Group C: Intravenous infusion 15 minutes before skin incision with 100 ml saline,local injection into the joint cavity after closure of the incision with 20 ml saline,combined with ABT.Observe and compare the general information of the three groups of patients,hemoglobin and platelets1,3,and 5 days after surgery,thrombin time,activated partial thromboplastin 3 days after surgery activated partial thromboplastin time,prothrombin time,fibrinogen,D-dimer,intraoperative blood loss,postoperative drainage volume,hidden blood loss,total blood loss,deep vein thrombosis incidence and other adverse events within 2 weeks after surgery(cerebral infarction,cerebral hemorrhage,pulmonary embolism,wound infection,etc.).Result: 1.The difference of age,height,weight,body mass index,fracture type,number of diseases with hypertension,diabetes,coronary heart disease,type of prosthesis,preoperative Hb and Plt and preoperative TT,APTT,PT,FIB,DD between the three groups were not statistically significant(P> 0.05).The difference of age,height,weight,body mass index,fracture type,number of cases with hypertension,diabetes,coronary heart disease,type of prosthesis,preoperative Hb and Plt and preoperative TT,APTT,PT,FIB,DD,between the three groups of patients without allogeneic blood transfusion were not statistically significant(P> 0.05).2.Effectiveness results: The intraoperative blood loss in group A and group B was lower than that in group C,the difference was statistically significant(P <0.05).Postoperative drainage volume,recessive blood loss,and total blood loss in group A were lower than those in groups B and C,the difference was significant(P <0.01).The three groups of patients without allogeneic blood transfusion had Hb at 1 day and 3 days after operation.Group A was higher than groups B and C.The difference was statistically significant(P <0.05).Comparing the difference between Hb and preoperative Hb at 1 and 3 days after operation,group A was lower than group B and group C,the difference was statistically significant(P <0.05).3.Safety results: There was no significant difference in the incidence of DVT and adverse events between the three groups within 2 weeks after operation(P> 0.05).There was no statistically significant difference in Plt 1,3,and 5 days after operation,TT,APTT,PT,FIB,and DD in three groups of patients without allogeneic blood transfusion(P> 0.05).Conclusion: TXA combined with ABT can reduce TBL in elderly FNF patients with unilateral THA,and has no adverse effect on coagulation function,and does not increase the incidence of deep vein thrombosis and of other adverse events.