International Orthopaedics | 2021
Comment on Shodipo et al.: comparison of single versus double tranexamic acid dose regimens in reducing post-operative blood loss following intramedullary nailing of femoral fracture nonunions
Abstract
Dear Editor, It was with great interest that we read the paper by Shodipo et al. [1] entitled “Comparison of single versus double tranexamic acid dose regimens in reducing postoperative blood loss following intramedullary nailing of femoral fracture nonunions” published online ahead of print, 2021 published online ahead of print, 2021 September 21 of International Orthopaedics. The authors found that doubledose peri-operative tranexamic acid regimen is superior to single-dose peri-operative tranexamic acid regimen in reducing post-operative blood loss in patients undergoing interlocking intramedullary nailing for femoral nonunions via performing a multicenter prospective randomized study. It is a valuable study. We would like to congratulate for their laudable efforts to perform this meticulous study. However, there are some issues that we would like to communicate with the authors. First, we found that the sole outcome measure of the study [1] was volume of blood drained by the suction drain which was removed at 48 hours post-operative. It is unfirm to draw the conclusion through a single index. As we all know, perioperative blood loss is divided into total blood loss (TBL), visible blood loss (VBL), and hidden blood loss (HBL) [2]. The TBL is the sum of the VBL during the operation, the HBL post-operatively, and transfusion [3]. It is vague whether the two groups of patients received transfusion and there will still be active bleeding after post-operative 48 hours or not. Therefore, we hope that the authors could evaluate the TBL, the VBL, and the HBL, respectively, to increase the reliability of the paper. Second, we hold that due to the multicentricity, it is possible that surgeons had different proficiency in this procedure and there were different management modes in various centres, which could have brought about a difference in the operation time. We did not find out the comparison of operative time in their study, which was deemed as an independent risk factor for peri-operative blood loss in some studies [3–5]. It is necessary to provide relevant information. Third, it should be paid attention to that some preoperative comorbidities of patients were not mentioned. Furthermore, it is confusing that the pre-operative investigations did not contain coagulation function, such as prothrombin time and activated partial thromboplastin time. Both above had an effect on the outcome. We sincerely hope the authors can supplement correlative details. In conclusion, we would like to voice our cordial thanks to Shodipo et al. [1] as a result of their hard work, once again. To reach a definitive conclusion, further high-quality studies based on larger sample sizes are still needed to assess the exact meaning of double tranexamic acid dose regimens in reducing post-operative blood loss.