Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomised controlled trial

Abstract Purpose: This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in proximal femoral nail antirotation (PFNA) surgery for intertrochanteric fractures in elderly individuals. Methods: A randomised controlled trial was conducted from January 2019 to December 2022. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Results: The total peri-operative blood loss in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 mL vs. 716.89 ± 420.30 mL; P < 0.031). The post-operative transfusion rate was 30.67% in the TXA group and 47.95% in the saline group (P = 0.031). The extent of post-operative deep venous thrombosis and the three-month mortality rate were similar between the two groups. Conclusion: We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.