JOT - 2026-09-09 - Journal Article
The Influence of Multiple Doses of Intravenous Tranexamic Acid on Transfusions and Complications in the Treatment of Fragility Hip Fractures.
Davis S, Solomito MJ, McCracken C, Kumar M
Topics
Key Takeaway
Multiple TXA doses did not reduce transfusion rates beyond a single dose (15.9% vs. 14.2%, p=0.791), while the multidose group had a higher VTE rate than the single-dose group (2.7% vs. 0.9%, p=0.040).
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Summary
This study compared no TXA, single-dose, and multidose IV TXA in 1,691 patients ≥50 years old undergoing surgery for fragility hip fractures (OTA 31A/31B) at a single Level I trauma center from 2018–2024. TXA use halved transfusion rates versus no TXA (single dose 15.9%, multidose 14.2% vs. no TXA 31.8%, p<0.001), but no incremental transfusion benefit was demonstrated beyond a single dose (p=0.791). VTE incidence was paradoxically higher in the multidose group (2.7%) compared to the single-dose group (0.9%, p=0.040), with no difference in 1-year mortality across groups.
Key Limitation
The non-randomized dosing allocation means the multidose group may represent systematically higher-risk patients (e.g., longer cases, greater anticipated blood loss), making the elevated VTE rate uninterpretable as a causal TXA effect without propensity-matched or adjusted analysis.
Original Abstract
OBJECTIVE
To determine the association between multiple intravenous tranexamic acid (TXA) doses and blood transfusions and complication rates in patient treated for fragility hip fractures.
DESIGN
Retrospective cohort study.
SETTING
Single Level I trauma center.
PATIENTS/PARTICIPANTS
Patients that were at least 50 years old and treated for a fragility fracture of the femoral neck (OTA31B), intertrochanteric (OTA31A1/A2), or subtrochanteric (OTA31A3) aspect of the femur between January 2018 and January 2024 were included .
INTERVENTION
TXA dosing (i.e. none, single dose, multiple doses) based on institutional protocols. TXA dosing was not based on intra-operative blood loss.
MAIN OUTCOMES
The primary outcomes were post-operative blood transfusions, venous thromboembolism (VTE), surgical site infections (SSI), and death within one year of surgery compared among the study groups (patients that received no TXA, a single dose, or multiple doses).
RESULTS
A total of 1,691 patients (632 patients [average age 81.4 (53 to 104), 71.8% female] did not receive TXA, 551 [average age 79.9 (51 to 102), 72.4% female] received a single TXA dose, 508 [average age 79.2 (51 to 100), 70.3% female] received multiple TXA doses). Surgical time did not differ between groups (no
TXA
72.6 ± 30.9 minutes, single dose: 74.9 ±32.9 minutes, and multiple doses: 70.6 ± 32.3 minutes, p=0.073). TXA use significantly reduced the risk of blood transfusion compared to the no TXA group (no
TXA
31.8%, single dose: 15.9%, multidose 14.2%, p<0.001). There were no significant differences in transfusion rates with two, three and four doses of TXA compared to the single dose group (single dose: 15.9%, two doses: 15.3% three doses 13.6% and four doses 13.1%, p=0.791). The frequency of VTE was the lowest in the single dose group compared to the other study groups (no
TXA
2.7%, single dose: 0.9%, multiple dose 2.7%, p=0.040). There was no difference in death rates among study groups (no
TXA
9.3%, single dose: 7.3%, multiple dose 8.5%, p=0.433).
CONCLUSION
Intravenous tranexamic acid (TXA) reduced transfusion needs without an increased complication rate in comparison to not using TXA. Regression analysis demonstrated that three and four doses of TXA did significantly reduce the transfusion rate beyond a single dose of TXA, but did not provide significant reduction beyond two-doses.
LEVEL OF EVIDENCE
Level 3.