Does the Synergistic Systemic and Local Application of Tranexamic Acid Reduce Blood Loss in Patients with Pertrochanteric Hip Fractures in the Elderly? Clinical Trial in a Tertiary Hospital Centre.

Abstract

There is a strong recommendation for the use of tranexamic acid in pertrochanteric fractures in the elderly; however, there is controversy about which doses and routes of administration are optimal. We aimed to determine whether intravenous administration, together with local application, offers a synergistic effect in reducing blood loss. We conducted a double-blind, randomized, placebo-controlled clinical trial comparing elderly patients (> 65 years) with pertrochanteric fractures, distributed into two groups:Treatment (n = 43): Received intravenous tranexamic acid (adjusted to the standard dose) and a local application of 3 g at the end of surgery.Control (n = 47): Received the same intravenous dose of tranexamic acid and a local placebo (3 g saline solution).The main variables were differences in blood loss measured by hemoglobin, hematocrit, and transfusion requirements. Perioperative hemoglobin losses did not show significant differences (p = 0.738), nor did hematocrit (p = 0.488) or perioperative transfusion requirements (p = 0.283). Analysis according to fracture characteristics and treatment (short nail vs. long nail without open reduction vs. long nail with open reduction) showed similar, non-significant results. Tranexamic acid in this patient group is beneficial on its own, but we did not observe a synergistic effect when combining intravenous and local administration. Our recommendation is single systemic use, given its simpler administration, lower dosage requirements, and equivalent therapeutic effect.