Perioperative Use of Tranexamic Acid Is Associated With Reduced Transfusion Rates in Femoral Shaft Fractures: A Propensity-Matched Cohort Study.

OBJECTIVES

To evaluate the association between perioperative tranexamic acid (TXA) use and transfusion rates, perioperative blood loss, and 90-day postoperative complications in patients undergoing intramedullary nailing of femoral shaft fractures.

DESIGN

Retrospective cohort study.

SETTING

Multicenter academic and community hospitals participating in the TriNetX research network.

PATIENT SELECTION CRITERIA: Adult patients (≥18 years) who underwent open intramedullary nailing of OTA/AO 32 (femoral diaphyseal) fractures between 2010 and 2025 were included. Patients with a history of malignant neoplasm, deep vein thrombosis (DVT), and pulmonary embolism (PE) were excluded. Patients were required to have ≥90 days of postoperative follow-up. The TXA group included patients who received perioperative TXA, while the comparison group did not.

OUTCOME MEASURES AND COMPARISONS: Primary outcomes included the incidence of nonautologous red blood cell transfusion and 90-day postoperative complications. Minor and major complications analyzed were mortality, DVT, PE, myocardial infarction, stroke, and renal failure. Propensity-score matching was performed to balance demographics and comorbidities. Chi-squared tests were used to compare outcomes.

RESULTS

A total of 7644 patients were included in the study. The mean age was 57.0 ± 23.2 in the TXA group (n = 3,822, 54.1% women) and 57.0 ± 23.2 in the non-TXA group (n = 3,822, 52.3% women). Transfusion rates were lower in the TXA cohort (8.37%) than in the non-TXA cohort (10.47%) [OR 0.78 (0.67-0.91); P = 0.002]. Mortality was also lower in the TXA group (1.31%) than in the non-TXA cohort (2.15%) [OR 0.60 (0.42-0.86), P = 0.005]. No significant differences were observed in DVT [ P = 0.298], PE [ P = 0.611], myocardial infarction [ P = 1.00], stroke [ P = 0.482], renal failure [ P = 0.479], readmissions [ P = 0.772], and reoperations [ P = 0.110].

CONCLUSIONS

Perioperative TXA use during intramedullary nailing for femoral shaft fractures was associated with a reduction in transfusion rates without an increase in short-term complications.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.