• William D Lack, Brett D Crist, Rachel B Seymour, William Harvin, Madhav A Karunakar, and TXA Study Group‖.
• *Department of Orthopedic Surgery, Loyola University Medical Center, Marywood, IL; †Department of Orthopedic Surgery, University of Missouri School of Health, Columbia, MO; ‡Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, NC; and §Department of Orthopedic Surgery, The University of Texas Health Science Center, Houston, TX.
• J Orthop Trauma. 2017 Oct 1; 31 (10): 526-530.

ObjectivesGiven the increasing evidence that minimizing blood loss and limiting allogeneic transfusion can improve patient outcome, we are performing a randomized controlled trial of the use of tranexamic acid (TXA) during acetabular fracture surgery.DesignProspective, multicenter, and randomized.SettingTwo level I trauma centers.ParticipantsEighty-eight patients underwent randomization, with 42 assigned to the TXA group and 46 assigned to the placebo group.InterventionThe use of TXA during acetabular fracture surgery.Main Outcome MeasurementsThe primary outcome was allogeneic blood transfusion. Secondary outcomes consisted of estimate blood loss (EBL) and venous thromboembolism (VTE).ResultsThe overall transfusion rate was 40.9% (36 of 88), and the average estimated blood loss was 635 mL. There were no significant differences between groups for transfusion incidence, number of units transfused, EBL, or incidence of VTE. There was no difference in transfusion rate for the TXA group (0.097). Transfusion was significantly more likely in cases with low preoperative hemoglobin levels, higher rates of intraoperative blood loss, and longer surgical times.ConclusionsThere was no significant difference in transfusion rate, EBL, or VTE for TXA versus placebo. Any potential benefit seems to be overwhelmed by other factors, specifically preoperative anemia and surgical time, which are highly variable in trauma surgery. These findings do not support the routine use of TXA in the setting of open reduction and internal fixation of acetabular fractures.Level Of EvidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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