Evaluation of the effects of tranexamic acid use on fracture healing in rat femur fracture model: An experimental study

Akın Sezgin, Evaluation of The Effects of Tranexamic Acid Use on Fracture Healing in Rat Femur Fracture Model: An Experimental Study. Zonguldak Bulent Ecevit University, Faculty of Medicine, Department of Orthopaedics and Traumatology. Orthopedics and Traumatology Thesis, Zonguldak, 2019. Tranexamic acid is a synthetic lysin derivative which becomes effective by reversibly blocking the lysin that attaches regions on plasminogen and preventing the fibrin degradation. Recently various agents are used, both during the emergency interventions for the patients with multiple traumas and active blood loss, and for the purpose of limiting the intraoperative and postoperative bleeding during the major orthopedic operations as well as stabilizing the hemodinamy as mush as possible. Among these agents, especially the tranexamic acid is the most prefered one. The studies mostly are focused on the effects of the tranexamic acid that are providing hemodynamics and minimizing the transfusion. Besides, some studies state that tranexamic acid has antiinflamatuary effects regardless of its antifibrinolitic effects. Considering that blood supply and inflammation play an important role in fracture healing, it is important to investigate the effects of tranexamic acid on fracture healing process. The aim of this study is; evaluation of the effects of administration of tranexamic acid in different ways and at different doses on fracture healing and the inflammatory process in the fracture site. 64 adult Wistar Albino type rats of the same sex(male) were included in the study. The study was planned to be carried out in 8 groups, each containing 8 rats. All groups had femoral shaft osteotomy+fixation. Groups A and B were not treated with tranexamic acid (control groups). C and D groups were injected 30 mg / kg IP tranexamic acid. E and F groups were injected 100 mg / kg IP tranexamic acid. G and H groups were applied 50 mg / kg of local tranexamic acid. The second week following the surgical operation, A-C-E-G groups and at postoperative fourth week 8 B-D-F-H groups were anesthetized and then sacrificed by cervical dislocation. Radiological, histopathological and immunohistochemical evaluation of the right femurs of the rats were performed by disarticulation of the hips and knees. As a result of our study, it has been observed that TA application has a negative effect on fracture healing and inflammation in general. It has been observed that local TA application can improve healing with the effect of increase in inflammation in the later phase while disturbing fracture healing in early phase. It was found that low dose (30 mg / kg) ip TA application had a negative effect on fracture healing in the later phase. It was determined that the degree of fracture healing was correlated with IL-6 values.