EFFECTIVENESS OF SINGLE DOSE PREOPERATIVE INTRAVENOUS TRANEXAMIC ACID ON REDUCTION OF PERIOPERATIVE BLOOD LOSS IN OPEN INTRAMEDULLARY NAIL FIXATION OF FEMORAL SHAFT FRACTURES IN MULAGO

Abstract

Background: Major Perioperative blood loss is one of the complications of open femoral shaft fracture intramedullary nailing surgery with average blood loss estimated at 1500mls. There is need for strategies to reduce this blood loss. Antifibrinolytic such as Tranexamic acid (TXA) have been successfully used to reduce perioperative blood loss in other orthopaedic procedures. However, effectiveness of TXA use during open femoral shaft fracture intramedullary nailing surgery has not been studied in our setting. Methods: This was a prospective cohort study, open label single arm trial conducted with forty-three patients scheduled for open femoral shaft fracture intramedullary nail fixation (ORIF) surgery receiving preoperative intravenous TXA at 15mg/kg. Blood loss using differences between 2 hours preoperative and 72 hours postoperative haemoglobin, blood transfusion rates and side effects in the perioperative period were assessed. Descriptive statistics; student T-test, Wilcoxon sum rank test were used for continuous variables and Chi square, Fischer’s test for categorical variables were used. Results: Forty-three patients participated 38(88.4%) were male and 5(11.6%) were females. Mean age 37 years SD 18. Average duration of injury 16 days SD = 9. Fracture patterns A-67.4%, B-12%, C-2%. Average duration of surgery = 1.7hours- SD 0.5. Average blood loss was 1.7g/dl SD = 0.6. Major predictors of blood loss were duration of injury 0.03 p<0.001, Type C fracture Pattern 0.55 p=0.043, duration of Surgery 0.66 p<0.001. Blood transfusion rate was 4.65%. Nine patients had minor side effects especially hypotension (60%). None of the patients had clinical features of thromboembolism. Conclusion: Preoperative treatment with Intravenous TXA is safe and can effectively reduce perioperative blood loss and the need for blood transfusion during femoral fracture intramedullary nail surgery.