JOT - 2026-03-16 - Journal Article
The Effect of Preoperative Tranexamic Acid on Blood Transfusions in Geriatric Hip Fracture Surgery: A Randomized Controlled Trial.
Sullivan M, Perea LL, Bradburn E, Guglielmo K, Bresz K, Horst M, Martin B, Heinle C, Tocks G
Topics
Key Takeaway
Preoperative IV TXA did not reduce postoperative transfusion rates versus placebo in geriatric hip fracture surgery (81% transfusion-free in both groups, p=0.97), with the trial terminated early for futility.
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Summary
This double-blinded RCT evaluated whether a single preoperative IV TXA dose reduces postoperative transfusion rates in patients ≥65 years undergoing operative hip fracture treatment (arthroplasty or internal fixation). The trial was terminated early after interim futility analysis; transfusion-free rates were identical at 81% in both TXA and placebo groups (p=0.97). No differences were detected in 30-day readmission, 90-day complications, HLOS, or 90-day mortality; however, ORIF carried a significantly higher transfusion rate than arthroplasty (25% vs. 8%, p<0.05) regardless of TXA allocation.
Key Limitation
Early termination for futility means the trial was underpowered to detect a clinically meaningful but modest TXA effect, and the null result cannot be interpreted as definitive equivalence.
Original Abstract
OBJECTIVES
To evaluate whether preoperative intravenous tranexamic acid (TXA) reduces postoperative blood transfusion rates in geriatric patients undergoing operative treatment for hip fracture.
METHODS
Design: Prospective, double-blinded, randomized controlled trial terminated early after interim futility analysis.
SETTING
Single-center Level I trauma center.
PATIENT SELECTION CRITERIA
Patients aged ≥65 years who underwent operative treatment for femoral neck (AO/OTA 31-B), intertrochanteric region (AO/OTA 31-A), or subtrochanteric (AO/OTA 32-A/B/C) fractures between June 2019 and June 2022 were included. Procedures included arthroplasty (hemiarthroplasty or total hip arthroplasty), and internal fixation (ORIF) with intramedullary nailing or sliding hip screw fixation. Exclusion criteria were recent thromboembolic events, cancer, hypercoagulable disorders, or TXA allergy.
OUTCOME MEASURES AND COMPARISONS
The primary outcome was postoperative transfusion. Secondary outcomes included hospital length of stay (HLOS), 30-day readmission, and 90-day complications and mortality. Statistical comparisons were performed using odds ratios, chi-squared, and t-tests, with significance thresholds adjusted by O'Brien-Fleming criteria.
RESULTS
283 patients were analyzed (TXA: 146 (mean age 84 (range 65-100), 71.9% female; Placebo: 137 (mean age 83.1 (range 65-100), 77.2% female). Baseline characteristics, including BMI and procedure type, were comparable (all p> 0.05). 229 patients (80.9%) required no postoperative transfusion (TXA 81%; Placebo: 81%, p=0.97). No significant differences were observed in 30-day readmission (p = 0.729), 90-day complications (p = 0.183), HLOS (p = 0.783), or 90-day mortality (p = 0.655). Subgroup analysis revealed higher transfusion rates in ORIF versus arthroplasty (ORIF 25%, Arthroplasty 8%, p < 0.05), though no difference between TXA and placebo within subgroups (p=0.38).
CONCLUSIONS
Preoperative TXA was not associated with reduced transfusion requirements in geriatric hip fracture surgery. No significant differences were observed in complications, mortality, or hospital stay. Surgical procedure may influence transfusion risk more than TXA use.
LEVEL OF EVIDENCE
Level I.