Application of Tranexamic Acid in Proximal Humerus Fracture

Background: Tranexamic acid (TXA) represents an antifbrinolytic agent that binds to plasminogen's lysine-binding sites, delaying fibrinolysis, and can be administered via intravenous, local, or intraarticular routes during joint surgery. Aim: The study aimed to compare between blood loss in patients with local administration of TXA and the patient without local administration of TXA in proximal humeral fracture. Methods: This comparative, prospective case control study was conducted on 30 patients with proximal humerus fracture who underwent fixed with plate and screws in the period from April 2023 to March 2024. Cases were divided into two groups (15 patients each), first group was injected with 30 ml TXA subcutaneous and intramuscular (case group), while the second group didn’t receive TXA (control group). Intra operative blood loss was estimated using the gauze and suction system. Also, post-operative blood loss was calculated in the drainage bag. A 24-hour period thereafter, post-operative CBC was done. Results: The outcomes revealed that there was no significant difference concerning the intraoperative blood loss (p-value = 0.174), which was decreased in the first group (average 295±109.3) compared to the second one (346±128.8). Postoperative blood loss was decreased in first group (mean 38±20.42), while was 68.67±19.86 in the second one with a significant difference between the two groups (p-value = 0.001). A significant drop in Hemoglobin (Hb) level was noticed (p-value = 0.027), which was less in the first group than in the second one. Conclusions: The local application of TXA in proximal humerus fracture has good clinical effectiveness and safety.