Safety and Effectiveness of the Topical Application of Tranexamic Acid to Reduce Drainage of Elderly Femoral Neck Fractures After Total Hip Arthroplasty: An observational pilot study

Background: There is a common disease of femoral neck fractures in elderly patients. And the incidence of postoperative wound bleeding and hyperfibrinolysis is very high. Tranexamic acid (TXA) has a certain effect in decreasing blood loss in orthopaedic surgery. A randomized controlled trial will assess the safety and effectiveness of TXA in decreasing drainage of elderly femoral neck fractures after total hip arthroplasty. Methods: 144 elderly femoral neck fractures are randomly and evenly divided into experimental group and control group, the experimental group receives 3g of infused retrogradely into the drainage tube tranexamic acid mixed in 100ml of saline after the operation and the control group receives an equivalent volume bolus of saline-infused retrogradely into the drainage after the operation. Observation indicators includedrainage volume, total drainage volume, and the postoperative hemoglobin loss on the 1st, 2nd, and 3rd day after operation, postoperative wound healing, cardiovascular and cerebrovascular events, and pulmonary embolism, etc. Data analysis was performed using SPSS 25.0 softwareand GraphPad InStat. Results: The estimated drainage volume was significantly lower in the experimental group than control group on the first day after operation and the second day after operation (p <0.05). And the hemoglobin and hematocrit levels on the first day after operation, the second day after operation, and the third day after operation in the experimental group were higher than those in the control group (P < 0.05). Moreover, there was no significant difference in coagulation function between the two groups, and a lack of significant intergroup differences in the postoperative complications, such as the incidences of deep vein thrombosis, pulmonary embolism, myocardial infarction, reoperation, and readmission or in terms of mortality rates. Conclusion: This clinical study demonstrated that topical application of  TXA administration safely reduced drainage and blood loss without affecting the coagulation function for elderly femoral neck fractures after total hip arthroplasty. Abbreviations: TXA=Tranexamic acid; PE=Pulmonary embolism; DVT=Deep vein thrombosis; BMI=Body mass index; MI=Miocardial infarction.