Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures.

Objectives: To determine the effect of a standardized tranexamic acid (TXA) protocol on red blood cell transfusions and adverse events in fragility hip fracture patients.

Design: Retrospective cohort study.

Setting: Academic Tertiary Care Center.

Patients/participants: Series of 209 patients with fragility hip fractures treated operatively from April 1, 2019 to September 30, 2019.

Intervention: Eligible patients received 4 intravenous doses of TXA. Some patients missed doses and only received between 1 and 3 doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture > 48 hours prior to presentation.

Main Outcome Measures: Red blood cell transfusion; major adverse vascular events; minor drug related adverse events.

Results: Patients who received all 4 doses of TXA (n = 70) had a significantly lower transfusion rate compared to those who did not receive any TXA (7.1% vs 28.1%,  = .003). There were no significant differences in the number of major or minor adverse events between the 2 groups.

Conclusions: The use of a standardized TXA protocol of 4 doses significantly decreases transfusion rates in eligible patients undergoing operative intervention for fragility hip fracture without an increase in major or minor adverse events. These findings are even more pronounced in patients with decreased preoperative hemoglobin. Prognostic Level III.