Intravenous Tranexamic Acid Reduces the Incidence of Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty: A Retrospective Cohort Study.

PURPOSE: This study aimed to investigate the effect of intravenous Tranexamic acid (TXA) on the incidence of postoperative delirium (POD) in elderly patients undergoing hip arthroplasty.

PATIENTS AND

METHODS

A total of 627 elderly patients undergoing hip arthroplasty were enrolled and stratified into the TXA group (n=336) or control group (n=291) based on intraoperative TXA administration. The primary outcome was the incidence of POD within the first 7 postoperative days, assessed daily using the Confusion Assessment Method (CAM). Secondary outcomes included blood loss, transfusion volume, Numeric Rating Scale (NRS) pain scores, thromboembolic events, and perioperative laboratory parameters (coagulation, inflammatory markers, and liver/kidney function).

RESULTS

Baseline characteristics were comparable between the two groups. A total of 193 patients developed POD, with the incidence being significantly lower in the TXA group compared to the control group (22.6% vs 40.2%, P < 0.001). The TXA group exhibited significantly reduced intraoperative blood loss and transfusion volumes, along with a lower transfusion rate (9.2% vs 17.5%, P < 0.05). No significant differences were observed in anesthetic opioid doses or the incidence of intraoperative hypotension between groups (P > 0.05). On postoperative day 2, levels of prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were significantly lower in the TXA group (P < 0.05). Conversely, no significant differences were observed in postoperative sufentanil consumption, or in the incidence of coagulation abnormalities or thromboembolic events. Furthermore, no significant differences in postoperative liver and renal function were observed between the two groups. Multivariate analysis identified intraoperative intravenous TXA administration and preoperative comorbid chronic obstructive pulmonary disease (COPD) scores as significant independent predictors of POD.

CONCLUSION

Intraoperative intravenous administration of TXA was associated with reduced systemic inflammation, less blood loss, lower pain scores, and a decreased incidence of POD in elderly patients undergoing hip arthroplasty.