Tranexamic acid: single topical application for femoral neck fractures treated with arthroplasty results in lowest blood loss.

Purpose: Tranexamic acid is widely accepted for hip fractures but there is no agreement about dose or application method and the use is still off label for hip fractures. The aim of our study was to find the best application method of tranexamic acid in patients with femoral neck fractures comparing total blood loss, hemoglobin and transfusion rate.

Methods: A retrospective single centre cohort study (level I trauma centre) with 2008 patients treated operatively for a proximal femur fracture between January 2016 and January 2022 was performed. 1 g of tranexamic acid was applied in 314 cases (systemic, topic or combined application) if patients consented. Patient data, surgical procedure, complications, and mortality were assessed. Haemoglobin levels, blood loss and transfusion rates were compared amongst application methods.

Results: For 884 femoral neck fractures treated with arthroplasty blood loss was significantly reduced by tranexamic acid which 314 had received in total (1151.0 ml vs 738.28 ml; p < 0.001). 151 patients received 1 g of tranexamic acid systemically which reduced blood loss from 1151 to 943.25 ml. Combined application of 1 g i.v. and 1 g topically reduced blood loss even further to 869.79 ml and topical application achieved the lowest total blood loss at 391.59 ml (average reduction of 759.41 ml compared to without tranexamic acid), p < 0.001. Transfusion rate and amount of RBC units transfused were the lowest for topical use and showed the highest hemoglobin levels postoperatively. Complication rates did not differ for adverse vascular events.

Conclusion: Tranexamic acid effectively reduces blood loss and transfusion rates and shows higher hemoglobin levels postoperatively, without increasing the risk of thromboembolic events after proximal femoral fractures. Single topic application of 1 g for arthroplasty treatment of femoral neck fractures has better results for blood loss reduction than single i.v. or combined application.