Year: 2026 | Month: July-September | Volume: 11 | Issue: 3 | Pages: 286-299
DOI: https://doi.org/10.52403/ijshr.20260332
Perioperative Intravenous Tranexamic Acid in Lower Limb Orthopaedic Trauma Surgery: Blood Loss, Transfusion Requirement, and Early Functional Recovery - A Prospective, Randomised, Assessor-Blinded Controlled Trial
Ashutosh Yadav1, Pushpa2, Sachin Kumar3
1Senior Resident, Department of Orthopaedics, Maharishi Chyawan Government Medical College, Koriawas, Narnaul, Haryana, India
2Assistant Professor, Department of Anaesthesia, Maharishi Chyawan Government Medical College, Koriawas, Narnaul, Haryana, India
3Senior Resident, Department of Orthopaedic Surgery, Balrampur Hospital, Golaganj, Lucknow, Uttar Pradesh, India
Corresponding Author: Dr. Ashutosh Yadav
ABSTRACT
Background: Operative fixation of lower limb fractures carries substantial perioperative blood loss and frequent allogeneic transfusion, with immunological, infective, and economic costs. Tranexamic acid (TXA), a lysine analogue that competitively inhibits plasminogen activation, is established in elective arthroplasty, but randomised data in acute lower limb trauma surgery remain limited, particularly in South Asian populations.
Objective: To compare a two-dose weight-based intravenous TXA regimen with normal saline for perioperative blood loss, transfusion requirement, and early functional recovery after operative fixation of lower limb fractures.
Methods: A prospective, randomised, parallel-group, assessor-blinded controlled trial was conducted at a tertiary care teaching hospital in Lucknow, India, between January 2022 and December 2023. One hundred and twenty adults undergoing fixation of intertrochanteric, femoral shaft, or tibial shaft fractures were randomised 1:1 by computer-generated block sequence with sealed opaque envelope concealment. The TXA group received 15 mg/kg intravenously 10 minutes pre-incision and an identical dose at wound closure; controls received matched volumes of normal saline. Primary outcomes were intraoperative blood loss, 48-hour drain output, fall in haemoglobin, and transfusion rate.
Results: Baseline characteristics were comparable. Intraoperative blood loss was 312.4 ± 78.2 mL with TXA versus 487.6 ± 93.8 mL with saline (mean difference 175.2 mL; 95% CI 139.6–211.8; p < 0.001). The 48-hour fall in haemoglobin was 1.82 ± 0.61 versus 3.14 ± 0.83 g/dL (p < 0.001). Transfusion was required by 15.0% versus 38.3% (p = 0.006; OR 0.29; 95% CI 0.12–0.72). Harris Hip Score at 24 weeks was 89.4 ± 6.1 versus 83.7 ± 7.2 (p < 0.001), a difference below conventional thresholds for clinical importance. Symptomatic deep vein thrombosis occurred in 1.7% versus 3.3% (p = 0.56); surveillance was clinically triggered rather than systematic.
Conclusion: A two-dose intravenous TXA regimen reduced blood loss and approximately halved allogeneic transfusion requirement in lower limb trauma surgery, without a detected excess of symptomatic thromboembolic events. Functional scores favoured TXA, but the magnitude of that difference was small and its relationship to blood conservation remains associative. Adequately powered multicentre trials with systematic thromboembolic screening are required before routine protocol adoption.
Keywords: Tranexamic acid, perioperative blood loss, orthopaedic trauma, blood transfusion, intertrochanteric fracture, functional outcome