title: Efficacy of Local Administration of Tranexamic Acid for Blood Salvage in Patients Undergoing Intertrochanteric Fracture Surgery.
abstract: OBJECTIVE
  The primary aim of this study was to assess whether local administration of tranexamic acid (TXA) reduced the need for a blood transfusion in elderly patients treated with an intramedullary (IM) nail for an intertrochanteric fracture.
  
  
  METHODS
  Randomized prospective trial.
  
  
  METHODS
  Academic level 1 trauma center.
  
  
  METHODS
  Two hundred patients (200 fractures) over 65 years with an intertrochanteric fracture treated by IM nail between April 1, 2012, and March 31, 2014.
  
  
  METHODS
  Subfascial administration of 3 g of TXA around the fracture site at the end of the surgical procedure, versus a control group without TXA. Follow-up ranged from 12 to 24 months.
  
  
  METHODS
  Group differences in number of transfused packed red blood cell (PRBC) units, and hematocrit, hemoglobin, and platelet count.
  
  
  RESULTS
  There was a 43% reduction in transfusion requirements in the TXA group (P < 0.01). Twenty-seven units of PRBC were transfused in 22/100 patients in the TXA group, whereas 48 PRBC units were transfused in 29/100 patients in control group. There was no difference between the 2 groups in terms of late complications and overall mortality rate.
  
  
  CONCLUSIONS
  Subfascial administration of TXA around the fracture site in elderly patients undergoing IM nailing for intertrochanteric fractures is safe and cost-effective. A significant reduction in blood loss and transfused blood units, and health care cost can be achieved.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece; and †Department of Orthopaedics, Attikon University Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Drakos
authors.forename: Vasilios
authors.initials: V
authors.lastname: Raoulis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karatzios
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Doxariotis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Kontogeorgakos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Malizos
authors.forename: Sokratis E
authors.initials: SE
authors.lastname: Varitimidis
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000401:mortality* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005593:Fracture Fixation, Internal / Q000401:mortality* / Q000706:statistics & numerical data; D006115:Greece / Q000453:epidemiology; D006489:Hemostatic Techniques; D006620:Hip Fractures / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid