Ulus Travma Acil Cerrahi Derg. 2018; 24(6): 575-580 | DOI: 10.5505/tjtes.2018.42147

Tibia kýrýklarýnýn intramedüller çivileme ile tedavisinde traneksamik asit kullanýmý güvenli ve güvenilir mi?

Sefa Giray Batýbay¹, Ýsmail Türkmen¹, Sedat Duman¹, Savaþ Çamur¹, Necdet Saðlam¹, Sevilay Batýbay^2
1Saðlýk Bilimleri Üniversitesi Ümraniye Eðitim ve Araþtýrma Hastanesi
²Saðlýk Bilimleri Üniversitesi haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi

Amaç: Tibia diafiz kýrýklarnda intramedüller çivileme yapýlýrken traneksamik asit kullanýmýnýn güvenli olup olmadýðýný, kan kaybýný azaltacaðýný ve maliyet etkinliðini etkilemeyeceðini belirlemek.
Hasta ve Yöntem: tibia diafiz kýrýðý olan 70 hasta randomize olarak iki gruba ayrýldý ve prospektif olarak kan kaybý, tromboz ve kýrýk iyileþmesi açýsýndan izlendi. Birinci gruba preoperatif traneksamik asit intravenöz olarak uygulandý. Ýkinci grup kontrol grubu olarak belirlendi.
Sonuç: Ýki grup arasýnda preoperastif ve postoperatif 1. saat Hb ve Hct deðerleri arasýnda farklýlýk saptanmadý. Ýki grup arasýnda postoperatif 24-48. saat Hb ve Hct deðerleri arasýnda anlamlý farklýlýk saptandý. Traneksamik asit uygulanan grupta (Grup A) postoperatif allojenik kan transfüzyonu gereksinimi olmadý. traneksamik asit kullanýlmayan grupta (Grup B) 2 hastaya Hb ve Hct deðerleri düþük saptanmasý üzerine (Hct<27) 1 ünite eritrosit süspansiyonu uygulandý. Hiçbir hastada DVT ve emboli gözlenmedi.
Sonuç: Ýntramedüller çivileme ile tibia kýrýklarýn tedavisinde preoperatif dönemde intravenöz Traneksamik asit uygulanmasý postoperatif dönemde kanama miktarýný azalttýðý gözlendi. Postoperatif dönemde hastalarda intravasküler tromboza yol açmadýðý gibi kemik iyileþmesini de olumsuz etkilemediði gözlenmiþtir.

Anahtar Kelimeler: Tibia diafiz kýrýðý, traneksamit asit, intramedüller çivileme

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Is tranexamic acid safe and reliable during tibial intramedullary nailing?

Sefa Giray Batýbay¹, Ýsmail Türkmen¹, Sedat Duman¹, Savaþ Çamur¹, Necdet Saðlam¹, Sevilay Batýbay^2
1Department of Orthopedics and Traumatology, Health Sciences University Ümraniye and Training and Research Hospital, Ýstanbul-Turkey
²Department of Physical Medicine and Rehabilitation, Health Sciences University Haydarpaþa Numune Training and Research Hospital, Ýstanbul-Turkey

BACKGROUND: The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced blood loss, or affected cost effectiveness.
METHODS: A total of 70 patients with a tibia diaphysis fracture were randomized into 2 groups and prospectively followed for data on blood loss, thrombosis, and fracture healing. Preoperative TXA was administered intravenously to Group A, and Group B served as the control group.
RESULTS: While there was no significant difference between the preoperative and postoperative 1-hour hemoglobin (Hb) and hematocrit (Hct) levels of the patients, there was a statistically significant difference in the comparison of the postoperative 24-hour and 48-hour Hb and Hct levels. There was no need for an allogenic blood transfusion to any patient in Group A; however, 2 patients in Group B each received 1 unit of erythrocyte suspension because their Hct values dropped below 27%. There was no deep vein thrombosis or embolism observed in any of the patients.
CONCLUSION: The application of intravenous TXA during the preoperative period in the treatment of tibial fractures with intramedullary nailing reduced the bleeding seen in the postoperative period. It did not lead to intravascular thrombosis in the postoperative period, and had no adverse effect on bone healing.

Keywords: Intramedullar nailing, tibia diaphyseal fracture; tranexamic acid

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