Tranexamic Acid
Tranexamic acid should be administered to reduce blood loss and blood transfusion in patients with hip fractures.


16 studies address the question of use of tranexamic acid in older adult patients with hip fractures (Chen 2019, Tenberg 2016, Tian 2018, Watts 2017, Zufferey 2010, Drakos 2016, Lei 2017, Ma 2021, Zhou 2019, Ashkenazi 2020, Kwak 2019, Lee 2015, Maalouly 2020, Schivaone 2018, Virani 2016, Xie 2019). 5 high quality studies (Chen 2019, Watts 2017, Tian 2018, Tengberg 2016, Zufferey 2010) and 6 lower quality studies (Zhou 2019, Drakos 2016, Lei 2017, Schiavone 2018, Xie 2019, Ashkenazi 2020) reported significantly lower blood loss and 3 high quality studies (Chen 2019, Watts 2017, Tian 2018) and 7 lower quality studies (Drakos 2016, Lei 2017, Kwak 2019, Xie 2019, Lee 2015, Ashkenazi 2020, Maalouly 2020) reported trends towards lower blood transfusions with TXA.  Tranexamic acid was not associated with higher incidence of mortality or symptomatic thromboembolic events.

 Benefits/Harms of Implementation

Use of tranexamic acid in hip fracture patients may result in lower blood loss and transfusion rates compared to placebo in a number of high quality studies.  Studies were unable to detect any difference in adverse events with use of tranexamic acid such as infection, wound complication, DVT, CVA, PE or MI (Chen 2019). One study (Zuffrey 2010) noted slightly increased asymptomatic VTE events as noted in the mandatory ultrasound. Caution may be exercised in patients with strong thrombotic risk factors as many of the studies excluded patients with previous thrombotic events.  

Outcome Importance

Patients with hip fractures may benefit from TXA to reduce blood loss and subsequent transfusion. 

Cost Effectiveness/Resource Utilization

Additional use of tranexamic acid in orthopaedic surgery has been demonstrated to be very cost effective in other areas of orthopaedic surgery, especially hip and knee replacement. Several studies additionally cite the better cost-effective nature of TXA when compared to transfusion. This intervention of TXA may offer potential cost savings for institutions as a health care system as a whole.

Future Research

Future research should determine which factors may place patients at higher risk for VTE or CVA, what is the optimal dose for tranexamic acid, and which mode of administration is best.