Effect of intraoperative tranexamic acid on blood loss and outcomes in intertrochanteric fractures: a retrospective study of 1728 patients.

PURPOSE

To evaluate the effect of intraoperative tranexamic acid (TXA) on perioperative blood loss, transfusion requirements, and clinical outcomes in patients undergoing proximal femoral nailing (PFN) for intertrochanteric fractures.

METHODS

A retrospective cohort study of 1,728 patients who underwent PFN fixation for intertrochanteric fractures between 2017 and 2024. Perioperative hemoglobin (Hb) dynamics, transfusion requirements, and clinical outcomes were compared between patients receiving 1-1.5 g intravenous TXA (n = 1,446) and controls (n = 282).

RESULTS

The TXA group demonstrated reduced perioperative Hb decline (2.15 ± 1.40 vs 2.76 ± 1.57 g/dL, p < 0.001) and lower rates of Hb drop > 2 g/dL (47.9% vs 63.5%, OR 0.53, p < 0.001). TXA administration was associated with decreased transfusion requirements (7.1% vs 11.0%, p = 0.021). Multivariate analysis confirmed TXA as an independent protective factor against blood loss. Mortality rates showed no significant difference between groups.

CONCLUSION

Intraoperative TXA during PFN fixation was associated with reduced perioperative blood loss and transfusion requirements. These findings support TXA as an effective blood conservation strategy in elderly patients with intertrochanteric fractures.