Role of tranexamic acid in terms of reducing perioperative blood loss and post operative transfusion requirement in fractures of proximal femur

Abstract

Objectives: To assess the effect of perioperative intravenous tranexamic acid (TXA) on the amount of blood lost postoperatively, as well as the requirement of blood transfusions in patients who underwent surgery for proximal femur fractures.

Methods: A comparative study was conducted at the Department of Orthopedics, Pakistan Air Force (PAF) Hospital, Islamabad, from November 2025 to January 2026. A total of 180 patients aged 18 to 65 years with proximal femur fractures (ASA I to II classification) were included in this study, divided into control and TXA groups. The control group (n = 90) patients who received no TXA, and the TXA group (n = 90) patients who received intravenous TXA perioperatively. Blood loss was measured based on hemoglobin drop and 24-hour drain output. Blood transfusion requirements were recorded according to institutional guidelines. The statistical analysis of the results was performed using SPSS version 25.

Results: The mean postoperative drain output in the TXA group was significantly less than that in the control group (312 ± 74 mL vs. 468 ± 96 mL; p < 0.001). Patients receiving TXA also had a lower mean postoperative hemoglobin drop (1.2 ± 0.5 g/dL vs. 2.1 ± 0.6 g/dL; p < 0.001). The TXA group had a significantly lower mean number of transfused units per patient (0.38 ± 0.72 vs. 0.89 ± 1.03; p = 0.001) and fewer patients needed postoperative blood transfusions (18.9% vs. 38.9%; p = 0.004). Thromboembolic or wound-related complications did not differ significantly.

Conclusion: The routine use of perioperative intravenous TXA in clinical practice is supported by the fact that it successfully lowers postoperative blood loss and transfusion requirements in proximal femur fracture surgery without increasing adverse events.