Tranexamic acid in elbow fracture surgery: impact on postoperative bleeding, fibrinolysis, and inflammation

BACKGROUND: The aim of this study was to investigate the effects of tranexamic acid (TXA) on drainage, calculated blood loss, fibrinolytic response, inflammatory response, and early clinical outcomes after internal fixation of traumatic elbow fracture.METHODS: This was a prospective cohort study with a randomized, controlled trial conducted from August 2022 to August 2023. A total of 124 patients who underwent elbow fracture surgery were randomly divided into the TXA group and the indomethacin group, with 62 cases in each group. The primary outcomes were the drainage volume, fibrinolytic index (FDP, D-Dimer), and inflammatory index (CRP, IL-6) 1 day and 3 days after the operation. Secondary outcomes included calculated blood loss, elbow pain score as measured on the Visual Analogue Scale (VAS), Mayo elbow function score, DASH score, and incidence of postoperative complications.RESULTS: The total drainage of the TXA group was significantly lower than that of the indomethacin group (P<0.05). The calculated blood loss of the TXA group was significantly lower than that of the indomethacin group on postoperative day 1 and day 3 (P<0.05). The fibrinolytic index (FDP, D-Dimer) and inflammatory index (CRP, IL-6) of the TXA group were significantly lower than those of the indomethacin group 1 and 3 days after the operation. The VAS scores were lower on the first and third postoperative days in the TXA group, but no significant differences at the last follow-up. No difference was found in the complication of HO. After an average of 10 months of follow-up, there were no significant differences in elbow joint range of motion, Mayo score, and DASH score between the two groups.CONCLUSIONS: TXA can reduce the drainage volume and estimated total blood loss after elbow fracture surgery, while also alleviating postoperative fibrinolytic and inflammatory responses.