Timing of tranexamic acid administration in elderly patients with intertrochanteric fracture

This study aimed to explore the safety and effects of tranexamic acid administration at different time points, in elderly patients with intertrochanteric fracture treated by proximal femoral nail anti-rotation (PFNA) measured by the blood loss in perioperative. A total of 120 elderly patients with intertrochanteric fracture admitted to our hospital from January 2016 to April 2018 were divided into group A (GA, n=40), group B (GB, n=40) and the control group (CG, n=40) according to different administration of treatment. The operation time, length of hospital stay, blood loss, changes of coagulation function, incidence of postoperative complications, joint function scores before and after operation, overall response rate, as well as Hb and Hct levels of the three groups were compared. The total blood loss, dominant blood loss, intraoperative blood loss, postoperative drainage volume, recessive blood loss and blood transfusion rate in GA and GB were lower than those in CG (P<0.05), and GB expressed lower total blood loss, postoperative drainage volume, recessive blood loss and blood transfusion rates than GA (P<0.05). No significant difference was observed in prothrombin time, activated partial thromboplastin time, fibrinogen incidences of limb swelling, intramuscular vein thrombosis and incision fat liquefaction among the three groups (P>0.05). After operation, Harris scores increased in all three groups and were highest in GB (P<0.05). The overall response rate, Hb and Hct levels of GB were higher than GA and CG at 1 d and 5 d after operation (P<0.05). Compared with single administration before operation, intravenous drip of tranexamic acid before and at 7 h after operation can effectively and safely reduce the blood and hemoglobin loss in elderly patients with intertrochanteric fracture and thus it is beneficial to postoperative recovery of joint function with a high overall response rate.