Intertrochanteric fractures (ITFs) are common in older adults and can result in significant blood loss at the fracture site and in perioperative blood loss. Reducing perioperative blood loss is essential to minimize complications and improve prognosis. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has been shown to reduce blood loss and transfusion rates in patients undergoing hip and knee replacement surgery.

However, the literature is complicated by variations in TXA administration methods, doses, fracture types, surgical options, and outcome evaluations type making it difficult to form evidence-based recommendations for the use of this drug.

Investigators performed a systematic review (SR) and meta-analysis (MA) of three databases (PubMed, Embase, and Cochrane Library) from their inception to August 2022 to better assess the effectiveness and safety of IV TXA in the management of geriatric ITFs with intramedullary nailing, which is a popular technique that is minimally invasive, has low intraoperative blood loss (IBL), and provides reliable fixation.

To be included in the SR and MA, studies had to be in English; enrolled patients aged 60 years or older who sustained an ITF and who underwent proximal femoral intramedullary nail surgery; involved the administration of IV TXA and a placebo/saline group (control group); were randomized, controlled trials (RCTs); and provided clinical outcome data on at least one of the following outcome measures, i.e., total blood loss (TBL), IBL, hidden blood loss (HBL), transfusion rate, transfusion units, mortality, and thromboembolic events.

Studies were excluded from analysis if they involved patients with open or multiple fractures; were retrospective analyses, review articles, case series, or case reports; or did not incorporate a desired outcome measure.

Six studies met the inclusion criteria and were included in the SR and MA. These studies were published between 2016 and 2021 and included 689 patients—340 in the TXA group and 349 in the control group. The trials were all deemed to be high-quality RCTs.

The investigators found that there were significant differences in favor of the use of IV TXA versus placebo for TBL (based on six studies; P <.00001); IBL (based on six studies; P <.00001); HBL (based on four studies; P <.00001); transfusion rates (decreased 47% based on six studies; relative risk [RR] = 0.53, P = .008); and transfusion units (reduced by 0.44 units per patient based on three studies, P <.01). There were no statistical differences in thromboembolic events (based on six studies; P = .42) or in mortality (based on four studies; P = .45) between IV TXA and placebo.

As the population ages, the rate of hip fracture is expected to rise. This article provides pharmacists with evidence-based medicine to help prevent perioperative bleeding in older patients who experience an ITF.

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