Intravenous Injection of Tranexamic Acid in Patients with Pelvic Fractures: A Prospective Randomized Trial

The purpose of the study is to examine the efficacy of intravenous injections of tranexamic acid (TXA) in reducing perioperative blood loss in patients scheduled for open reduction and internal fixation for pelvic fractures (Tile B and C). A study population with greater homogeneity was selected to minimize confounding variables related to fracture and fixation methods that may reflect an accurate result.

A prospective randomized controlled trial including 100 patients who received either 15 mg/kg of TXA added to 40 mL saline twice separated by 3 hours interval or a similar volume of normal saline (~50 mL twice in same manner) intravenously. Measurement of hemoglobin was performed preoperatively and postoperatively. Blood loss in drain, blood units transfused, and complications were recorded.

The mean decrease in hematocrit levels (preoperatively and postoperatively) was 3.2% in the trial group versus 3.7% in the control group (P>0.05). Mean total blood loss was 1,106 and 1,340 mL (trial vs. control group [P<0.05]). The mean operative time was 122.5 and 130.3 minutes (trial vs. control group [P>0.05]). Mean collected blood from the drain was 155 and 170 mL (trial vs. control group [P>0.05]). The transfusion rate was 28% and 76% while the mean for transfused units was 0.72 and 1.1 units (trial vs. control group [P<0.05]). There were no venous thromboembolic events.

Intravenous injection of TXA in pelvic fractures was effective in reducing blood loss and the rates of blood transfusion. There were no associated thromboembolic complications.