Abstract: Objective To compare the clinical efficacy of aminocaproic acid and tranexamic acid in reducing perioperative blood loss in the elderly patients with intertrochanteric fractures undergoing closed reduction and internal fixation with intramedullary nailing. Methods A retrospective analysis was conducted to assess the clinical data of 98 elderly patients who underwent surgery for intertrochanteric fractures from January 2020 to December 2022.The patients were divided into two groups based on intravenous administration of either aminocaproic acid (48 cases) or tranexamic acid (50 cases). Blood loss indicators and the incidence rate of complications were compared between the two groups. Results There were no significant differences in age, gender, height, weight, body mass index (BMI), preoperative hematocrit and total blood volume between the groups (P>0.05). The total blood loss volume and hidden blood loss volume within 24 hours after surgery, blood transfusion rate, total transfusion volume in the tranexamic acid group were significantly lower than those in the aminocaproic acid group (P<0.05). However, there were no significant differences in total blood loss and hidden blood loss 24-72 hours after surgery, hematocrit at 24 and 72 hours, intraoperative blood loss volume, postoperative drainage, hospital stay, operation time and the incidence rate of postoperative venous thrombosis and poor wound healing between the two groups (P>0.05). Conclusions The use of tranexamic acid during surgery in the elderly patients with intertrochanteric fractures is more effective in reducing perioperative blood loss volume, particularly hidden blood loss, compared to aminocaproic acid.Therefore, tranexamic acid is recommended as the preferred antifibrinolytic agent during surgery for intertrochanteric fractures in the elderly patients.

Key words: aminocaproic acid, tranexamic acid, intertrochanteric fracture, blood loss