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Abstract Objective To assess the impact of tranexamine acid on the hidden blood loss in intertrochanteric fractures treated with Asia proximal femoral nail anti-rotation(APFNA)and related complications.Methods A randomized controlled study was used.A total of 80 elderly patients with APFNA internal fixation for intertrochan teric fractures in the Department of Orthopedics of Tongzhou District Hospitalin Beijing from April 2017 to August 2018 were included and randomly divided into two groups by random number table method.The observation group was treated with tranexamic acid and the control group with or without tranexamic acid.In the observation group，there were a total of 40 patients，including 11 males and 29 females，the average age was (76.15±7.55)years (65~91 years).Patients in the observation group were treated with 1g tranexamic acid added to 250 mL 0.9% sodium chloride injection while undergoing intraoperative dermectomy.A total of 40 patients were included in the control group，including 13 males and 27 females，the average age was (76.28±7.57)years (65~91 years).Patients in the control group were treated with 250 mL 0.9% sodium chloride injection by slow intravenous drip.Gender，height，weight，operation time，RBC hematocrit before and after operation，intraoperative and postoperative blood loss were observed in the 2 groups.Color ultrasound examination of lower limb veins was performed 10 days after operation to determine whether there was thrombosis.Results The total blood loss was (681.29±148.04)mL in the observation group and (973.85±186.50)mL in the control group.There was statistically significant difference (P＜0.05).The average invisible blood losswas (529.79±56.10)mL in the observation group and (817.35±92.89)mL in the control group，and the difference was statistically significant (P＜0.05).The average dominant blood losswas (151.50±93.80)mL in the observation group and (156.50±95.15)mL in the control group，and the difference was not statistically significant (P＞0.05).There were no cases of thrombosis in either group.5 patients (12.50%) in the observation group received blood transfusion，with an average transfusion volume of 1.40 U.In the control group，13 patients (32.50%，13/40) received blood transfusion，with an average of 2.55 U.The difference in blood transfusion rate between groups was statistically significant (P＝0.033)，while the difference in average blood transfusion volume between groups was not statistically significant (P＞0.05).Conclusion After the treatment of intertrochanteric fractures with APFNA，hidden blood lossis a large proportion of total blood loss，close to 85%，the application of tranexamic acid can effectively reduce the elderly intertrochanteric fracture with APFNA both total blood loss and hidden blood loss，postoperative of hidden blood loss can reduce about 35%，and did not significantly increase the incidence of DVT.The treatment has high security and good operability.
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