Tranexamic Acid Administered at Time of Hospital Admission Does Not Decrease Transfusion Rates or Blood Loss for Extracapsular Hip Fractures; A Double-Blinded Randomized Clinical Trial

Abstract

Objectives: To evaluate TXA when administered immediately upon hospital presentation in patients with extracapsular peritrochanteric hip fractures to determine its effect on 1.) transfusion rates 2.) estimated blood loss, and 3.) complications. Methods: Design: Prospective, double-blinded, randomized clinical trial. Setting: Single Center, Level 1 Trauma Center Patient Selection Criteria: All patients with isolated AO/OTA 31-A fracture patterns from 2018-2022 were eligible for inclusion. Study drug was administered in the emergency department at the time of presentation – 1-gram bolus over 10 minutes followed by a 1-gram infusion over 8 hours. Outcome Measures and Comparisons: The primary outcome was the rate of red blood cell (RBC) transfusion hospital day #1 – #4. Secondary outcomes included estimated blood loss and complications including venous thromboembolic events (VTE), stroke, myocardial infarction (MI), all-cause 90-day readmissions, and all-cause mortality. Results: 128 patients were included – 64 patients were randomized to intravenous (IV) TXA and 64 patients to IV normal saline (i.e., placebo). There was no difference in the rate of RBC transfusion between treatment arms between hospital day #1 – #4 (27% in TXA arm vs. 31% in placebo arm, p=0.65). Patients randomized to placebo that required transfusion received a mean of 2.30 units compared to 1.94 units in the TXA cohort (p=0.55). There was no difference in the estimated blood loss between hospital day #1 – #4. There was no difference in the incidence of postoperative complications including VTE, stroke, MI, 90-day readmission, or death. Conclusions: The results of the current study do not support the use of preoperative TXA for reducing blood loss for geriatric patients with extracapsular hip fractures. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.