Abstract
Background Patients with neck of femur (NOF) fractures experience high morbidity and transfusion rates. Tranexamic acid (TXA) routinely reduces perioperative blood loss in elective lower limb arthroplasties; however, its use in fragility fracture management remains variable, and there is no nationally agreed guideline for its use in hip fracture surgery. This study aims to evaluate the impact of TXA administration on transfusion rates, postoperative hemoglobin drop, in-hospital complications, and 30-day mortality in patients with NOF fractures at a UK-based teaching hospital. Methods A retrospective audit at a university trauma unit evaluated TXA use in patients with NOF fractures from July to December 2024. Of 184 cases identified, 26 were excluded (preoperative death, transfer, or non-NOF fractures), leaving 158 patients for analysis. Patients were grouped based on TXA administration. The primary outcome was the need for blood transfusion intraoperatively or within one week postoperatively. Secondary outcomes included postoperative hemoglobin drop, thromboembolic events, and 30-day mortality. Results Among 158 patients, 144 (91.1%) received TXA. Transfusion rates were significantly lower in the TXA group (22.2%) compared with non-TXA patients (50.0%) (χ² = 5.30, p = 0.021). Mean postoperative hemoglobin drop was smaller with TXA (17.1 ± 13.4 g/L vs. 22.8 ± 17.2 g/L; Z = -2.34, p = 0.019). Binary logistic regression identified TXA as an independent protective factor (OR: 0.164, 95% CI: 0.042-0.648, p = 0.011), while female sex, American Society of Anesthesiologists (ASA) grade III-IV, and extracapsular fractures were independent predictors of transfusion. There was no significant difference in thromboembolic events (3.5% vs. 7.1%, p = 0.432) or 30-day mortality (6.3% vs. 21.4%, p = 0.095), suggesting TXA did not increase these risks. Conclusion In this cohort, perioperative TXA use in operative NOF fracture management significantly reduced transfusion rates and hemoglobin drop without a significant effect on 30-day mortality and no effect on thromboembolic events. These findings support routine TXA use as a low-risk, cost-effective adjunct in the surgical management of patients with NOF fractures.