Perioperative efficacy of tranexamic acid in the treatment of proximal humeral fractures in elderly patients

doi:10.3877/cma.j.issn.2095-5790.2025.01.004

Abstract

Abstract:

Background

With the increasing aging of society， the incidence， disability rate，mortality rate， and related medical costs of proximal humeral fracture （PHF） are all showing a rising trend， which has become a public health problem that cannot be ignored.According to epidemiological investigations， PHF has become the third most common fracture type in older adults after hip and distal radius fractures.For severely displaced PHF， surgical treatment aims to achieve ideal reduction and fixation，stabilize the fracture end， and facilitate the patients to perform shoulder joint functional exercises in the early stage.However， surgical treatment is often faced with many difficulties， such as the inability to use a tourniquet， osteoporosis， bone defects， difficulty reduction， etc.， which increase the risk of intraoperative bleeding.For elderly patients， intraoperative bleeding may not only increase the need for postoperative blood transfusion but also directly threaten the life safety of patients and increase perioperative mortality.Tranexamic acid （TXA）， an anti-fibrinolytic drug， has been widely used in joint surgery.According to relevant studies， TXA can effectively reduce perioperative blood loss and transfusion volume in hip and knee replacement surgery patients.However， there are few reports on the application of TXA in elderly patients undergoing PHF surgery.

Objective

To investigate the efficacy and safety of preoperative intravenous administration of TXA in elderly patients undergoing internal fixation for PHF.

Methods

This study retrospectively analyzed the clinical data of 75 elderly patients with PHF who underwent open reduction and internal fixation surgery in Beijing Chaoyang Hospital， Capital Medical University， from December 2017 to December 2021.Patients were divided into a TXA group （45 cases） and a control group （30 cases）according to whether they received preoperative intravenous TXA therapy.Patients in the TXA group were given 1 g TXA intravenously 30 minutes before surgery， while those in the control group were not given TXA.We compared baseline characteristics， perioperative blood loss （including total， overt， recessive， and intraoperative blood loss）， transfusion rate， postoperative hematological indicators （hemoglobin， hematocrit，and platelet count）， and postoperative complications between the two groups.Statistical significance was determined by P＜0.05.

Results

Compared with the control group， the TXA group significantly reduced perioperative blood loss.The total blood loss in the TXA group was substantially lower than that in the control group （P＜0.01）， and the dominant blood loss （P＜0.01） and recessive blood loss （P＜0.01） were also significantly reduced.Although there was no significant difference in intraoperative blood loss between the two groups （P＞0.05）， the postoperative drainage flow and drainage tube removal time in the TXA group were significantly lower than those in the control group （P＜0.01）.The hemoglobin level of the TXA group was higher than that of the control group on day 1， day 3， and day 5 after the operation， especially on day 1（P=0.01）.Regarding hematocrit， the TXA group was significantly higher than the control group on day 1 and day 3 after surgery （P=0.01 and P=0.006）， but there was no significant difference in hematocrit level on day 5.There was no significant difference in platelet count between the two groups （P＞0.05）.In addition，the length of hospitalization in the TXA group was significantly shorter than that in the control group（P＜0.01）.The incidence of postoperative complications was similar between the two groups， and there were no adverse events such as thromboembolism.

Conclusion

Preoperative intravenous application of TXA can effectively reduce perioperative blood loss in elderly patients with PHF， maintain good postoperative hemoglobin and hematocrit levels， and significantly shorten hospital stay， which is conducive to rapid postoperative recovery of patients and has good clinical effectiveness and safety.

Key words: Proximal humerus, Fracture, Tranexamic acid, Internal fixation, Blood loss

Lingrao Zhou, Binzhi Zhao, Yang Liu, Junlin Zhou, Yanrui Zhao. Perioperative efficacy of tranexamic acid in the treatment of proximal humeral fractures in elderly patients[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2025, 13(01): 26-32.

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URL: https://zhjzwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5790.2025.01.004

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Figures/Tables 6

组别	例数	性别（男/ 女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²）	Neer 分型			抗血小板药物	高血压
组别	例数	性别（男/ 女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²）	二部分	三部分	四部分	抗血小板药物	高血压
对照组	30	14/16	74.7±4.2	22.3±3.7	11	15	4	10	10
TXA 组	45	17/28	75.5±3.4	21.9±3.1	16	22	7	11	14
t/χ ²值		0.59	-0.91	0.51		0.07		0.71	0.04
P值		0.44	0.82	0.61		0.97		0.41	0.84
组别	例数	糖尿病	冠心病	受伤至手术时间（d， $\overset{ˉ}{x}$ ± s ）	ASA 分级				凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）	活化部分凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）
组别	例数	糖尿病	冠心病	受伤至手术时间（d， $\overset{ˉ}{x}$ ± s ）	I	II	III	IV-V	凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）	活化部分凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）
对照组	30	5	4	6.1±3.1	16	12	2	0	12.9±1.7	31.5±5.8
TXA 组	45	7	7	6.5±2.6	20	21	4	0	12.4±1.4	32.3±6.3
t/χ ²值		0.01	0.07	0.60		1.39			1.40	-0.56
P值		0.99	0.79	0.55		0.45			0.17	0.57

组别	例数	性别（男/ 女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²）	Neer 分型			抗血小板药物	高血压
组别	例数	性别（男/ 女）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²）	二部分	三部分	四部分	抗血小板药物	高血压
对照组	30	14/16	74.7±4.2	22.3±3.7	11	15	4	10	10
TXA 组	45	17/28	75.5±3.4	21.9±3.1	16	22	7	11	14
t/χ ²值		0.59	-0.91	0.51		0.07		0.71	0.04
P值		0.44	0.82	0.61		0.97		0.41	0.84
组别	例数	糖尿病	冠心病	受伤至手术时间（d， $\overset{ˉ}{x}$ ± s ）	ASA 分级				凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）	活化部分凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）
组别	例数	糖尿病	冠心病	受伤至手术时间（d， $\overset{ˉ}{x}$ ± s ）	I	II	III	IV-V	凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）	活化部分凝血酶原时间（s， $\overset{ˉ}{x}$ ± s ）
对照组	30	5	4	6.1±3.1	16	12	2	0	12.9±1.7	31.5±5.8
TXA 组	45	7	7	6.5±2.6	20	21	4	0	12.4±1.4	32.3±6.3
t/χ ²值		0.01	0.07	0.60		1.39			1.40	-0.56
P值		0.99	0.79	0.55		0.45			0.17	0.57

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ± s ）	TBL（ml， $\overset{ˉ}{x}$ ± s ）	VBL（ml， $\overset{ˉ}{x}$ ± s ）	HBL（ml， $\overset{ˉ}{x}$ ± s ）	IBL（ml， $\overset{ˉ}{x}$ ± s ）	引流量（ml， $\overset{ˉ}{x}$ ± s ）
对照组	30	96.9±16.4	392.8±31.4	203.1±21.3	200.6±22.8	134.7±31.3	76.9±17.1
TXA 组	45	92.5±17.3	281.1±22.7	124.3±18.2	132.1±21.1	129.5±25.4	50.5±10.5
t/χ ²值		1.14	18.84	17.39	13.38	0.78	8.21
P值		0.27	＜ 0.01	＜ 0.01	＜ 0.01	＜ 0.43	＜ 0.01
组别	例数	引流管拔除时间（h， $\overset{ˉ}{x}$ ± s ）	输血率［例（%）］	术中植骨	住院时间（d， $\overset{ˉ}{x}$ ± s ）	并发症发生率［例（%）］
对照组	30	38.2±5.2	3（10）	9	10.2±2.7	1（2.2）
TXA 组	45	25.4±3.4	4（8.8）	12	6.9±1.8	1（3.3）
t/χ ²值		13.02	0.03	0.22	6.26	0.09
P值		＜ 0.01	0.99	0.72	＜ 0.01	0.99

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ± s ）	TBL（ml， $\overset{ˉ}{x}$ ± s ）	VBL（ml， $\overset{ˉ}{x}$ ± s ）	HBL（ml， $\overset{ˉ}{x}$ ± s ）	IBL（ml， $\overset{ˉ}{x}$ ± s ）	引流量（ml， $\overset{ˉ}{x}$ ± s ）
对照组	30	96.9±16.4	392.8±31.4	203.1±21.3	200.6±22.8	134.7±31.3	76.9±17.1
TXA 组	45	92.5±17.3	281.1±22.7	124.3±18.2	132.1±21.1	129.5±25.4	50.5±10.5
t/χ ²值		1.14	18.84	17.39	13.38	0.78	8.21
P值		0.27	＜ 0.01	＜ 0.01	＜ 0.01	＜ 0.43	＜ 0.01
组别	例数	引流管拔除时间（h， $\overset{ˉ}{x}$ ± s ）	输血率［例（%）］	术中植骨	住院时间（d， $\overset{ˉ}{x}$ ± s ）	并发症发生率［例（%）］
对照组	30	38.2±5.2	3（10）	9	10.2±2.7	1（2.2）
TXA 组	45	25.4±3.4	4（8.8）	12	6.9±1.8	1（3.3）
t/χ ²值		13.02	0.03	0.22	6.26	0.09
P值		＜ 0.01	0.99	0.72	＜ 0.01	0.99

组别	例数	术后血红蛋白（g/dL）
组别	例数	术前	术后当天	术后1 d	术后3 d	术后5 d
对照组	30	12.1±1.1	10.9±1.6	10.4±1.4	10.9±1.3	11.5±1.6
TXA 组	45	12.3±1.3	11.7±1.5	11.3±1.6	11.9±1.5	12.1±1.4
t 值		-0.72	-2.20	-2.51	-2.95	-1.71
P值		0.48	0.03	0.01	0.01	0.09
组别	例数	术后红细胞压积（%）
组别	例数	术前	术后当天	术后1 d	术后3 d	术后5 d
对照组	30	37.8±4.3	30.5±3.8	28.1±4.3	30.4±4.1	31.1±3.9
TXA 组	45	38.4±4.2	33.1±3.7	30.8±3.9	31.9±3.8	32.3±4.2
t 值		-0.62	-2.95	-2.69	-1.63	-1.27
P值		0.54		0.01	0.11	0.21
组别	例数	血小板（×10⁹/L）
组别	例数	术前	术后当天	术后1 d	术后3 d	术后5 d
对照组	30	244.5±63.4	233.5±59.2	240.4±60.5	267.9±61.2	301.4±63.2
TXA 组	45	246.6±68.9	244.9±60.3	246.7±60.7	278.8±62.8	310.4±62.1
t 值		-0.14	-0.81	-0.44	-0.74	-0.62
P值		0.89	0.42	0.66	0.46	0.54

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