J Orthop Trauma. 2019 Mar 29; Epub ahead of print

# Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial.

Spitler C, Kiner D, Row E, Gardner W, Swafford R, Hankins M, Nowotarski P

OBJECTIVES: Assess the safety and efficacy of tranexamic acid(TXA) use in fractures of the pelvic ring, acetabulum, and proximal femur

DESIGN: Prospective, randomized controlled trial

SETTING: Single Level 1 trauma center

PATIENTS: Fourty-seven patients were randomized to the study group and 46 patients comprised the control group INTERVENTION:: The study group received 15mg/kg IV TXA prior to incision and a second identical dose 3 hours after the initial dose.

MAIN OUTCOME MEASUREMENTS: transfusion rates, total blood loss (via hemoglobin dilutional method, rates of venous thromboembolic events)

RESULTS: Total blood loss was significantly higher in the control group (TXA=952mL, No TXA=1325mL, p=0.028). The total transfusion rates between the TXA and control groups were not significantly different (TXA 1.51, No TXA= 1.17, P=0.41). There were no significant differences between the TXA and control groups in inpatient VTE events (p=0.57) CONCLUSION:: The use of TXA in high-energy fractures of the pelvis, acetabulum and femur significantly decreased calculated total blood loss but did not decrease overall transfusion rates. TXA did not increase the rate of VTE. Further study is warranted prior to making broad recommendations for use of TXA in these fractures.