Abstract: Objective To evaluate the efficacy and safety of topical use of tranexamic acid(TXA)to reduce hidden blood loss after femoral intertrochanteric fracture fixation with PFNA. Methods A total of 113 femoral intertrochanteric fracture patients treated with PFNA were randomly divided into two groups, treatment group(n=57), and control group (n=56). For patients in the treatment group, 2 g TXA dissolved in 20 mL normal saline was injected into the femur medullary cavity after proximal femur reaming. For patients in the control group, 20 mL normal saline was injected. The hidden blood loss, total perioperative blood loss, visible blood loss and transfusion rate, and complications of vascular events were compared between the two groups. Results The hidden blood loss, total perioperative blood loss, and transfusion rate in the treatment group and control group were(572±79)vs(703±106)mL,(770±75)vs(892±83)mL, and 40.3% vs 60.7%. There were significant differences between the two groups(all P<0.05). There were no significant differences in visible blood loss and vascular events between the two groups(P>0.05). Conclusions Topical use of TXA can significantly reduce hidden blood loss and transfusion rate after intertrochanteric fracture internal fixation with PFNA, without increasing risks of vascular events complications.

Key words: Tranexamic acid, Femoral intertrochanteric fracture, Fracture fixation, Proximal femoral nail antirotation, Hidden blood loss