Does Tranexamic acid Reduce Blood Loss and Transfusion Rate in Undernourished Patients with Hip Fracture?

Abstract

Tranexamic acid (TXA) has been widely used to reduce blood loss and postoperative transfusion rate in orthopedic surgeries. This study aimed to investigate the safety and effectiveness of TXA in undernourished older adults with hip fracture. A total of 216 patients were classified into undernutrition and normal groups, based on the Geriatric Nutritional Risk Index. Eighty-two patients were randomized to receive intravenous TXA at 15 mg/kg before incision; another 1 g was administered intravenously for 3 h postoperatively. The association between TXA administration and perioperative hemoglobin (Hb) drop, blood transfusion rate, and deep venous thrombosis (DVT) rate, after controlling for patient demographics, was investigated. Of the patients, 51.9% were undernourished with progressive anemia (Hb: 10.9 ± 1.5 g/dL). More femoral neck fractures and fewer trochanteric fractures likely occurred in undernourished patients. TXA administration significantly reduced the Hb drop rather than the transfusion rate, regardless of the nutritional status. There was a high prevalence of undernutrition in older adults with hip fractures. Undernutrition can not only deteriorate muscle strength and gait function, leading to different types of hip fractures, but may also interfere with the processing of TXA in reducing the blood transfusion rate.