To investigate the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE), and cardio-cerebral embolism in elderly patients with intertrochanteric fracture.

A retrospective analysis was performed on 411 elderly patients with intertrochanteric fracture who received proximal femoral nail anti-rotation internal fixation from January 2017 to January 2021 at Civil Aviation General Hospital. According to whether TXA was used perioperatively or not, the patients were divided into a hemostatic group (265 cases) and a non-hemostatic group (146 cases). The hemostatic group was given an intravenous infusion of 1 g/100 ml TXA before intraoperative skin resection and after operation. In contrast, TXA and similar hemostatic drugs were not used in the non-hemostatic group. Intraoperative latent and dominant blood loss, total blood loss, transfusion rate, hemoglobin (Hb) and hematocrit (Hct) at 1, 2, 3, 7, and 14 d after surgery, activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (DD) at 3, 7, and 14 d after surgery, and the incidence of VTE, cardio-cerebral embolism, and mortality at 3 months after surgery were compared between the two groups.

Intraoperative latent and dominant blood loss, total blood loss, and transfusion volume in the hemostatic group [(586.73±130.08) ml, (204.37±45.31) ml, (791.09±175.39) ml, and (263.89±93.91) ml, respectively] were significantly lower than those in the non-hemostatic group [(733.23±168.14) ml, (260.98±59.85) ml, (994.21±227.99) ml, and (383.67±207.51) ml, respectively; P＜0.05]. Hb level at 2, 3, 7, and 14 d after surgery in the hemostatic group [(87.99±11.04) g/L, (95.32±7.79) g/L, (99.87±7.55) g/L, and (108.68±8.09) g/L, respectively] was significantly higher than that in the non-hemostatic group [(85.25±9.30) g/L, (92.12±7.07) g/L, (97.16±6.78) g/L, and (105.25±6.88) g/L, respectively; P＜0.05], and Hct level at 3d after surgery in the hemostatic group [(28.98±2.96)%] was significantly higher than that in the non-hemostatic group [(27.47±2.70)%; P＜0.05]. There were no significant differences in postoperative APTT, FIB, DD, blood transfusion rate, or the incidence of VTE, cardio-cerebral embolism, and mortality between the two groups (P＞0.05).

Perioperative use of TXA can effectively reduce intraoperative blood loss and blood transfusion in elderly patients with intertrochanteric fracture while not increasing the incidence of VTE and did not increase the risk of cardio-cerebral embolism.