Background: 

For elective total joint arthroplasty, tranexamic acid (TXA) is considered safe and efficacious. However, evidence of TXA’s safety in high-risk patients undergoing nonelective surgery for hip fracture is sparse. This study aimed to assess whether TXA administration to high-risk patients with an intertrochanteric (IT) hip fracture increased the risk of thromboembolic complications or mortality.

Methods: 

All patients treated surgically for IT hip fracture between 2015 and 2019 across 4 hospitals of a single hospital system were considered. High- versus low-risk patients and those receiving TXA versus no TXA treatment were identified. Propensity scores adjusted for risk differences between patient groups with TXA and no TXA administration were calculated for (1) high-risk patients (n = 141) and (2) the entire population (n = 316). Postoperative mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and stroke within 90 days of surgery were evaluated.

Results: 

No association between TXA administration and increased risk of mortality or complications in either group was identified. Specifically, out of 282 matched high-risk patients, no differences in mortality (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.90, 1.05]), DVT (OR, 0.97 [95% CI, 0.93, 1.00]), PE (OR 1.00 [95% CI, 0.95, 1.05]), MI (OR, 1.04 [95% CI, 0.98, 1.10]), or stroke (OR, 1.00 [95% CI, 0.95, 1.05]) were identified.

Conclusions: 

In our review of propensity-matched high-risk patients undergoing surgical repair for IT fracture, we found that TXA administration compared with no TXA administration was not associated with an increased risk of mortality, DVT, PE, MI, or stroke within 90 days of surgery.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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氨甲环酸与高危转子间骨折患者并发症增加无关

背景： 

对于选择性全关节置换术，氨甲环酸（TXA）被认为是安全有效的。然而，对于因髋部骨折接受非选择性手术的高危患者，TXA 的安全性证据很少。本研究旨在评估对患有粗隆间 (IT) 髋部骨折的高危患者给予 TXA 是否会增加血栓栓塞并发症或死亡的风险。

方法： 

考虑了 2015 年至 2019 年间在单一医院系统的 4 家医院接受手术治疗的 IT 髋部骨折的所有患者。确定了高风险与低风险患者以及接受 TXA 与未接受 TXA 治疗的患者。计算了（1）高风险患者（n = 141）和（2）整个人群（n = 316）的倾向评分，调整了接受 TXA 和未给予 TXA 的患者组之间的风险差异。评估手术后 90 天内的术后死亡率、深静脉血栓形成 (DVT)、肺栓塞 (PE)、心肌梗死 (MI) 和卒中。

结果： 

未发现 TXA 给药与任一组死亡或并发症风险增加之间存在关联。具体而言，在 282 名匹配的高危患者中，死亡率（优势比 [OR]，0.97 [95% 置信区间 (CI)，0.90，1.05]）、DVT（OR，0.97 [95% CI，0.93， 1.00])、PE (OR 1.00 [95% CI, 0.95, 1.05])、MI (OR, 1.04 [95% CI, 0.98, 1.10]) 或中风 (OR, 1.00 [95% CI, 0.95, 1.05] ) 被识别。

结论： 

在我们对接受 IT 骨折手术修复的倾向匹配的高风险患者的回顾中，我们发现与未使用 TXA 相比，给予 TXA 与术后 90 天内死亡、DVT、PE、MI 或中风的风险增加无关。手术。

证据等级： 

治疗级别 IV。有关证据级别的完整描述，请参见作者说明。