JOT - 2026-08-24 - Journal Article
Effect of Perioperative Tranexamic Acid on Blood Loss in Posterior Acetabular Fracture Fixation.
Yeager MT, Rutz RW, Dekle JK, Alcaide DM, Litten RM, McIlwain RN, Fisher MM, Fortin TA, Ellis JD, Johnson JP, Spitler CA
Topics
Key Takeaway
Perioperative IV TXA was not independently associated with calculated total blood loss (β = 32.5 mL; 95% CI, -123.2 to 188.2; p = 0.682) following posterior approach acetabular fracture fixation in 591 patients.
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Summary
This study asked whether perioperative IV TXA reduces total blood loss and transfusion requirements in posterior approach acetabular ORIF. On multivariable regression controlling for fracture characteristics and operative duration, TXA use was not independently associated with calculated TBL (β = 32.5 mL, p = 0.682), transfusion rates, perioperative hemoglobin, or hospital LOS. Longer operative duration and fracture-specific features—not TXA use—were the independent predictors of greater blood loss.
Key Limitation
Retrospective non-randomized design with systematic differences in fracture complexity between TXA and no-TXA groups (higher comminution and intraarticular fragments in the no-TXA group) that multivariable adjustment may not fully resolve, potentially masking a true TXA effect.
Original Abstract
OBJECTIVE
To evaluate the impact of perioperative intravenous (IV) tranexamic acid (TXA) on total blood loss (TBL) and transfusion requirements in patients who underwent acetabular fracture fixation (AO/OTA 62) via a posterior surgical approach. The authors hypothesized that patients who received perioperative IV TXA would demonstrate lower TBL compared with those who did not receive perioperative TXA.
METHODS
Design: Retrospective cohort study.
SETTING
Single Level I trauma center (2010-2023).
PATIENT SELECTION CRITERIA
Adult patients who underwent acetabular fracture (AO/OTA 62) fixation through a posterior surgical approach from 2010 to 2023.
OUTCOME MEASURES AND COMPARISONS
The primary outcome was TBL among patients receiving perioperative TXA versus no TXA. Secondary outcomes were hospital length of stay (LOS), postoperative hemoglobin at 24 and 48 hours, and transfusion requirements.
RESULTS
A total of 591 patients met inclusion criteria, of which 186 (31.5%) received perioperative IV TXA and 405 (68.5%) did not. The TXA group had a mean age of 39.7 years (range, 18-80 years) and included 123 male patients (66.1%), while the no-TXA group had a mean age of 38.6 years (range, 18-89 years) and included 273 male patients (67.4%). Age (p = 0.396) and BMI (p = 0.489) did not differ between groups. The TXA group demonstrated a higher rate of protrusio (9.7% vs. 4.4%, p = 0.016) but lower rates of intraarticular fragments (34.9% vs. 47.2%, p = 0.006) and wall comminution (41.4% vs. 51.4%, p = 0.027). On unadjusted analysis, patients receiving TXA demonstrated shorter operative duration (171.4 vs 188.5 minutes, p = 0.036), whereas calculated TBL did not differ between groups (p = 0.600). On multivariable regression, perioperative TXA use was not independently associated with calculated TBL (β = 32.5 mL; 95% CI, -123.2 to 188.2; p = 0.682). There were no differences in perioperative hemoglobin values (all p ≥ 0.063), intraoperative or postoperative transfusion requirements (all p ≥ 0.493), hospital LOS (p = 0.750), or postoperative complications, including thromboembolic events, fracture-related infection, heterotopic ossification, or all-cause mortality (all p ≥ 0.381).
CONCLUSION
Perioperative IV TXA use was not independently associated with calculated TBL following posterior approach acetabular fracture fixation. Instead, longer operative duration and fracture-related characteristics were independently associated with greater TBL. TXA use was also not associated with differences in transfusion requirements or short-term postoperative outcomes.
LEVEL OF EVIDENCE
III.