Efficacy and safety of perioperative tranexamic acid in elderly patients undergoing trochanteric fracture surgery: a randomised controlled trial

Introduction: Trochanteric fractures result in a high frequency of considerable blood loss, a high incidence of blood transfusions, and a high risk of perioperative morbidity and mortality in elderly patients. This study aimed to evaluate the efficacy and safety of a three-dose regimen of tranexamic acid on blood loss and transfusion rate in elderly patients with trochanteric fractures. Methods: Eligible patients with trochanteric fractures surgically treated by dynamic hip screw and proximal anti-rotating intramedullary nail between March 2016 and October 2017 were enrolled in the study. Patients were randomly assigned to receive 15 mg/kg intravenous tranexamic acid dissolved in 100 mL of saline (TXA group) or 100 mL of saline solution (placebo group) over 10 minutes before, during, and after surgery. Perioperative blood loss, obvious blood loss, and hidden blood loss in the two groups were calculated separately. Vascular events and patient mortality over 6 months' follow-up were noted. Results: In total, 176 patients were included. Compared with the placebo group (n=88), patients in the TXA group (n=88) had less blood loss: perioperative blood loss was 205.5 mL (P<0.001), obvious blood loss was 125 mL (P<0.001), and hidden blood loss was 76.5 mL (P<0.001); reduced incidence of blood transfusion (17% vs 35%, P=0.007); and shorter hospital stays (median [interquartile range], 7 [6-8] vs 8.5 [7.5-9] days, P<0.001). Conclusion: Tranexamic acid significantly lowered perioperative blood loss and blood transfusion rate without an increased risk of venous thromboembolism or mortality in elderly patients with trochanteric fractures treated with dynamic hip screw or proximal anti-rotating intramedullary nail.