Impact of Intravenous Tranexamic Acid at Hospital Admission on Blood Transfusion Rates in Geriatric Extracapsular Hip Fracture Patients.

Abstract

Geriatric hip fractures often require allogenic blood transfusions, which increases the risk of transfusion related complications. Tranexamic acid (TXA) has been shown to have a positive effect on hip fractures, with the American Academy of Orthopedic Surgeons (AAOS) recommending its use; however, optimal dosing and timing has not been delineated in the literature. This study evaluates the effectiveness of early TXA administration in reducing transfusion rates in extracapsular geriatric hip fracture patients. From 2021 to 2023, a retrospective chart review compared geriatric fragility hip fracture (AO/OTA 31A) patients who received TXA at admission (1-g IV at presentation and 1-g IV three hours later) with those who did not. The primary outcome evaluated was allogenic blood transfusion rates. Patient demographics, hemoglobin levels during admission, hidden blood loss, length of hospital stay, and 90-day perioperative complications were also recorded. Among 168 patients, 102 received TXA and 66 did not. There was no statistically significant difference in allogenic transfusion rates between the groups (<i>p</i> = 0.27). Secondary outcomes, including hemoglobin/hematocrit levels, hidden blood loss, and length of hospital stay, were also similar. Thromboembolic event rates were comparable. Our findings align with recent literature that questions TXA's effectiveness in reducing transfusion rates in this population. Early TXA administration may not adequately address hidden blood loss in geriatric hip fractures, possibly due to high comorbidity burden, pre-existing anemia, and delayed surgery. Further research is necessary to explore alternative strategies for managing early blood loss and optimizing outcomes in this population.