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SYSTEMATIC REVIEW article

Front. Surg.

Sec. Orthopedic Surgery

Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1681209

This article is part of the Research TopicPerioperative Management and Clinical Challenges in Elderly Major Surgical PatientsView all articles

Impact of Tranexamic Acid on Hidden Blood Loss in Intertrochanteric Fractures: A Meta-analysis of Randomized Controlled trials

Provisionally accepted
Yan  MengYan Meng1Yong  ZhangYong Zhang2Hanzhong  XueHanzhong Xue1Ning  DuanNing Duan1Zhong  LiZhong Li1Qian  WangQian Wang1Yao  LuYao Lu1*
  • 1Xi'an Jiaotong University, Xi'an, China
  • 2People's Liberation Army Beidaihe Rest and Recuperation Center, Qinhuangdao, China

The final, formatted version of the article will be published soon.

Background: Intertrochanteric fractures (IFs) are a common type of fracture in the elderly and are often associated with substantial hidden blood loss (HBL) due to trauma and surgery. Tranexamic acid (TXA) has emerged as a potential intervention to reduce perioperative bleeding. This study aimed to evaluate the safety and efficacy of TXA administration in elderly patients with IFs undergoing intramedullary nailing, through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Web of Science, Cochrane Library, Embase, and PubMed were searched for relevant RCTs published from inception to January 2025. Data on HBL, total blood loss (TBL), transfusion rate, and thromboembolic events were extracted. Review Manager 5.3.5 was used to assess the safety and efficacy of TXA. Results: Eight RCTs involving 735 patients (363 in the TXA group and 372 in the control group) were included in the meta-analysis. The TXA group demonstrated significantly lower HBL (standard mean difference [SMD] = −0.59; 95% confidence interval [CI], −0.74 to −0.45) and TBL (SMD = −0.74; 95% CI, −0.91 to −0.58), as well as a reduced transfusion rate (relative risk [RR] = 0.50; 95% CI, 0.35 to 0.72) compared with the control group. Additionally, no significant difference in thromboembolic events was found between the two groups. Conclusions: Current evidence indicates that TXA significantly reduces HBL and transfusion requirements without increasing the risk of thromboembolic events in elderly patients with IFs.

Keywords: Intertrochanteric fractures, Tranexamic Acid, Hidden blood loss, Hip Fractures, Mortality

Received: 07 Aug 2025; Accepted: 20 Oct 2025.

Copyright: © 2025 Meng, Zhang, Xue, Duan, Li, Wang and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Yao Lu, drluyao@163.com

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