To explore the value of tranexamic acid (TXA) in reducing perioperative blood loss in patients with obese intertrochanteric fractures treated with closed reduction and PFNA internal fixation.

Retrospective analysis of clinical data of 80 patients with obesity who underwent closed reduction PFNA internal fixation at Wuyi Traditional Chinese Medicine Hospital of Jiangmen City from November 2013 to November 2018 due to intertrochanteric fractures. Patients were divided into TXA and non-TXA groups based on whether perioperative TXA was used. Patients in TXA group were intravenously infused with tranexamic acid 20 mg/kg 15 minutes before skin incision, and 3 g of tranexamic acid was diluted in 50 ml of normal saline before the skin was sutured and then injected retrogradely through the drainage tube into the incision. The non-TXA group replaced tranexamic acid with an equal amount of normal saline. The perioperative coagulation function, intraoperative blood loss, total blood loss and invisible blood loss, the blood transfusion rate, and the hemoglobin before and after the operation 1 and 3 days of the two groups of patients were compared. We also recorded the DVT and incidence of PE of each patient.

There was no significant difference in the APTT, PT, and D dimer levels between the two groups of patients before surgery (P>0.05). And there was no difference in the comparison of the APTT, PT, and D dimer levels between the two groups at 1 and 3 days after surgery (P>0.05); the total blood loss, blood loss during surgery, hidden blood loss, and blood transfusion rate in the TXA group were significantly lower than those in the non-TXA group (P<0.05); hemoglobin in the TXA group at 1 and 3 days after surgery was significantly higher than that in the non-TXA group (P<0.05). There was no significant difference in the incidence of PE and DVT formation between the two groups of patients (P>0.05).

TXA can reduce perioperative blood loss in obese patients with femoral intertrochanteric fractures treated with closed reduction PFNA internal fixation without increasing the risk of deep vein thrombosis and pulmonary embolism.