Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial.
AIMS
We chose unstable extra-capsular hip fractures as our study group because these types of fractures suffer the largest blood loss. We hypothesised that tranexamic acid (TXA) would reduce total blood loss (TBL) in extra-capsular fractures of the hip.


PATIENTS AND METHODS
A single-centre placebo-controlled double-blinded randomised clinical trial was performed to test the hypothesis on patients undergoing surgery for extra-capsular hip fractures. For reasons outside the control of the investigators, the trial was stopped before reaching the 120 included patients as planned in the protocol.


RESULTS
In all 72 patients (51 women, 21 men; 33 patients in the TXA group, 39 in the placebo group) were included in the final analysis, with a significant mean reduction of 570.8 ml (p = 0.029) in TBL from 2100.4 ml (standard deviation (sd) = 1152.6) in the placebo group to 1529.6 ml (sd = 1012.7) in the TXA group. The 90-day mortality was 27.2% (n = 9) in the TXA group and 10.2% (n = 4) in the placebo group (p = 0.07). We were not able to ascertain a reliable cause of death in these patients.


DISCUSSION
TXA significantly reduced TBL in extra-capsular hip fractures, but concerns regarding its safety in this patient group must be investigated further before the use of TXA can be recommended.


TAKE HOME MESSAGE
We present a randomised clinical trial that is unique in the literature. We evaluate the effect of TXA in very homogenous population - extra-capsular fractures operated with short intramedullary nails. Cite this article: Bone Joint J 2016;98-B:747-53.
['Tengberg|P T|PT|', 'Foss|N B|NB|', 'Palm|H|H|', 'Kallemose|T|T|', 'Troelsen|A|A|']
D000368:Aged D000933:Antifibrinolytic Agents D016063:Blood Loss, Surgical D001803:Blood Transfusion D003718:Denmark D004311:Double-Blind Method D057239:Early Termination of Clinical Trials D005260:Female D005594:Fracture Fixation, Intramedullary D006454:Hemoglobins D006620:Hip Fractures D017052:Hospital Mortality D006801:Humans D008297:Male D014148:Tranexamic Acid
Tranexamic acid Blood loss Hip-fracture