Oral versus intravenous tranexamic acid in elderly patients with intertrochanteric fracture undergoing proximal femur intramedullary nailing: A prospective cohort study

Objective: To investigate and compare the efficacy and safety of intravenous and oral application of tranexamic acid (TXA) in geriatric patients undergoing intertrochanteric fracture surgeries. Methods: All patients with intertrochanteric fracture admitted to the trauma center of the Zhongda hospital were selected after January 1st, 2020. The final patients were divided into three groups. Oral group: 2 g oral TXA 2 h preoperatively; intravenous group: 15 mg/kg intravenous TXA before incision; control group: no intervention. The main outcome measures were blood transfusion rate and total blood loss. Secondary outcomes include intraoperative blood loss, postoperative blood loss, perioperative blood transfusion volumes, length of hospital stay, thromboembolism events and other adverse events. Results: From January 1, 2020 to December 31, 2020, 124 patients with intertrochanteric fracture were enrolled. According to the inclusion and exclusion criteria, 105 patients were included, including 32 patients in the oral group, 36 patients in the intravenous group and 37 patients in the control group. The demographic characteristics of each group were similar. The blood transfusion rate in the control group was significantly more than that in the experimental group (64.9% vs 40.6% vs 36.1%, P = 0.041). There was no significant difference between the oral group and the intravenous group (P = 0.704). The total blood loss of the oral group and the intravenous group were less than the control group (990.29 +/- 250.19 ml vs 997.47 +/- 452.34 ml vs 1408.54 +/- 461.74 ml), the difference was statistically significant (P = 0.001), and there was no significant difference between the intravenous group and the oral group (P = 0.459). The perioperative blood transfusion volumes of the oral group and the intravenous group were less than the control group (250.00 +/- 198.62 ml vs 227.78 +/- 179.27 ml vs 367.57 +/- 323.90 ml), the difference was statistically significant (P = 0.001), and there was no significant difference between the intravenous group and the oral group (P = 0.832). During hospitalization and follow-up, there were no thromboembolism events such as deep vein thrombosis and pulmonary embolism. Conclusion: It is safe and effective to use TXA intravenously and orally in elderly patients with intertrochanteric fracture. The results of the two methods are similar in safety and effectiveness. Oral TXA is recommended because of its cost-benefit superiority and its ease of administration. The translational potential of this article: The result of this prospective cohort study shows that the utilization of oral TXA in elderly patients with intertrochanteric fracture undergoing proximal femur intramedullary nailing possesses great potential in reducing blood loss and cost-benefit superiority.