Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review

Abstract

OBJECTIVE: Evaluate differences between blood transfusion and complication rates among fragility hip fracture patients treated with locally injected (Local) versus intravenous (IV) tranexamic acid (TXA). METHODS Design: Retrospective comparative cohort Setting: Tertiary referral orthopedic specialty hospital; Level I trauma center Patient Selection Criteria: Patients aged 50 years and over who underwent surgical treatment for a proximal femur fragility fracture (OTA/AO 31A and 31B). between March 2018 and April 2022 with or without the use of local TXA during wound closure or IV TXA. Outcome Measures and Comparisons: Post-operative blood transfusion, venous thromboembolism (VTE), surgical site infections (SSI), and 30-day readmissions compared between those who received IV TXA, Local TXA, and controls that did not receive any TXA. RESULTS: 746 patients (258 received IV TXA, 252 received Local TXA, and 236 control that did not receive any TXA) were studied. Both Local and IV TXA groups received fewer blood transfusion versus controls. IV TXA was associated with a transfusion rate reduction of 12% compared to Local TXA (p<0.001). Regression analysis indicated that IV TXA reduced the odds of a post-operative blood transfusion by 48% compared to Local TXA (p=0.017). There were no differences in complication rates among the groups; however, patients receiving IV TXA had a significantly lower 30-day readmission rate (5%) than the control (13.9%) or Local (13.8%) TXA groups (p=0.001). CONCLUSION: Intravenous TXA significantly reduced the risk of postoperative transfusion compared to controls and patients receiving Local TXA. There was no increased risk of complications, and a lower 30-day readmission was observed for the IV TXA group. IV TXA appears to be a safe and effective way to reduce post-operative blood transfusion in patients with fragility hip fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.