Perioperative multidose tranexamic acid combined with erythropoietin and iron isomaltoside supplementation reduces transfusion requirements of elderly patients with intertrochanteric fractures.

Abstract

Perioperative anaemia and blood transfusion are common complications in elderly patients with intertrochanteric fractures, impacting recovery. This study aimed to evaluate whether a combined approach of early, continuous antifibrinolytic therapy with tranexamic acid (TXA) plus erythropoietin (EPO) and intravenous iron isomaltoside (IM) reduces transfusion requirements compared to TXA alone or standard care. This retrospective analysis included 134 patients aged > 70 years with intertrochanteric fractures treated with proximal femoral nail antirotation. Three perioperative blood management protocols were compared: Control group receiving a single 1 g dose of intravenous TXA; TXA group receiving sequential 1 g TXA every 12 h for 48 h; and TXA + EPO/IM group receiving the sequential TXA regimen plus a single 1000 mg dose of IM and daily 40,000 U EPO. The primary outcome was total perioperative transfusion rate. Secondary outcomes included hidden blood loss (HBL), haemoglobin (Hb) levels, and 90-day complications. From post-traumatic day 2 (POD 2) to POD 3, HBL was significantly lower in the TXA and TXA + EPO/IM groups compared to the control group (P < 0.05). On PODs 2 and 3, Hb levels in the TXA + EPO/IM group were significantly higher than in the TXA group (P < 0.05). The total transfusion rate was significantly lower in the TXA + EPO/IM group (14.0%) compared to both the TXA (32.6%) and Control (63.8%) groups (P < 0.05). The incidence of thromboembolic events and other complications was similar across all three groups. TXA early and continuous antifibrinolytic therapy combined with EPO/IM rapid iron supplementation and erythropoiesis appears to safely and effectively reduce the perioperative blood transfusion rate and the occurrence of anemia in elderly patients with intertrochanteric fractures without increasing complication risk.