Intraoperative tranexamic acid use in elderly patients with intertrochanteric fractures: impact on early postoperative inflammation and clinical outcomes

Background and purpose Tranexamic acid (TXA) demonstrates anti-inflammatory effects during surgery. However, the clinical value of the TXA in intertrochanteric fractures patients has not been further investigated. This study aimed to investigate the effects of intraoperative tranexamic acid (TXA) administration on early postoperative inflammatory markers and clinical outcomes in elderly patients with intertrochanteric fractures. Patients and methods A total of 136 patients (59 males and 77 females) aged 62–96 years were enrolled. Patients were divided into two groups: 68 received TXA [TXA group, intravenous drip (15 mg/kg)] and 68 did not receive TXA (control group). We compared surgical duration, total blood loss (TBL), hidden blood loss (HBL), transfusion rates, incidence of deep vein thrombosis (DVT), length of hospital stay, serum interleukin-6 (IL-6) levels on postoperative days 1, 3, 5, and 7, and visual analog scale (VAS) scores. Results The TXA group exhibited significantly lower TBL (981.74 ± 451.14 mL vs. 1206.27 ± 408.22 mL, p = 0.002), HBL (890.94 ± 409.99 mL vs. 1104.39 ± 412.06 mL, p = 0.003), and transfusion rates (32.3% vs. 51.4%, p = 0.037) compared with the control group. Serum IL-6 levels and VAS scores were significantly lower in the TXA group on postoperative days 1 and 3 (p < 0.05). The complication rate within one year was also lower in the TXA group (26.4% vs. 48.5%, p = 0.032). No significant differences were observed between groups for surgical duration, DVT incidence, length of hospital stay, or one-year mortality (p > 0.05). Conclusion Intraoperative TXA administration appears to effectively reduce blood loss, attenuate the inflammatory response, and lower complication rates in elderly patients undergoing surgery for intertrochanteric fractures.