Effect of Perioperative Tranexamic Acid on Blood Loss in Posterior Acetabular Fracture Fixation

OBJECTIVE: To evaluate the impact of perioperative intravenous (IV) tranexamic acid (TXA) on total blood loss (TBL) and transfusion requirements in patients who underwent acetabular fracture fixation (AO/OTA 62) via a posterior surgical approach. The authors hypothesized that patients who received perioperative IV TXA would demonstrate lower TBL compared with those who did not receive perioperative TXA. METHODS: Design: Retrospective cohort study. SETTING: Single Level I trauma center (2010-2023). PATIENT SELECTION CRITERIA: Adult patients who underwent acetabular fracture (AO/OTA 62) fixation through a posterior surgical approach from 2010 to 2023. OUTCOME MEASURES AND COMPARISONS: The primary outcome was TBL among patients receiving perioperative TXA versus no TXA. Secondary outcomes were hospital length of stay (LOS), postoperative hemoglobin at 24 and 48 hours, and transfusion requirements. RESULTS: A total of 591 patients met inclusion criteria, of which 186 (31.5%) received perioperative IV TXA and 405 (68.5%) did not. The TXA group had a mean age of 39.7 years (range, 18-80 years) and included 123 male patients (66.1%), while the no-TXA group had a mean age of 38.6 years (range, 18-89 years) and included 273 male patients (67.4%). Age (p = 0.396) and BMI (p = 0.489) did not differ between groups. The TXA group demonstrated a higher rate of protrusio (9.7% vs. 4.4%, p = 0.016) but lower rates of intraarticular fragments (34.9% vs. 47.2%, p = 0.006) and wall comminution (41.4% vs. 51.4%, p = 0.027). On unadjusted analysis, patients receiving TXA demonstrated shorter operative duration (171.4 vs 188.5 minutes, p = 0.036), whereas calculated TBL did not differ between groups (p = 0.600). On multivariable regression, perioperative TXA use was not independently associated with calculated TBL (β = 32.5 mL; 95% CI, -123.2 to 188.2; p = 0.682). There were no differences in perioperative hemoglobin values (all p ≥ 0.063), intraoperative or postoperative transfusion requirements (all p ≥ 0.493), hospital LOS (p = 0.750), or postoperative complications, including thromboembolic events, fracture-related infection, heterotopic ossification, or all-cause mortality (all p ≥ 0.381). CONCLUSION: Perioperative IV TXA use was not independently associated with calculated TBL following posterior approach acetabular fracture fixation. Instead, longer operative duration and fracture-related characteristics were independently associated with greater TBL. TXA use was also not associated with differences in transfusion requirements or short-term postoperative outcomes. LEVEL OF EVIDENCE: III.