{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:57:17Z","timestamp":1781269037013,"version":"3.54.1"},"reference-count":41,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","award":["ICI21\/00084"],"award-info":[{"award-number":["ICI21\/00084"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,22]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In patients with a hip fracture, anaemia has been associated with increased transfusion requirements, poor functional outcomes, prolonged hospital stays and increased mortality. While anaemia in elderly patients with hip fractures has traditionally been attributed to bleeding during or after surgery, many of these patients are anaemic on hospital admission. Thus, detecting and managing anaemia in the perioperative, postoperative and, most significantly, the preoperative period is important to avoid the need for blood transfusions and to improve patient outcomes. The protocol for this clinical trial is designed to evaluate the efficacy and safety of both combined intravenous and topical tranexamic acid (TXA) therapy, or topical administration alone, assessing its effect on blood loss and the need for blood transfusions in elderly patients undergoing hip fracture surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a multicentre, double-blinded, randomised, placebo-controlled trial with a 1:1 allocation ratio. Patients of both sexes, aged \u226565 years, who are admitted to the emergency department and will undergo hip fracture surgery are eligible for enrolment. Eligible patients who provide their consent will be stratified according to the type of fracture (intracapsular and extracapsular) and whether or not they are suitable for intravenous TXA therapy, and they will then be randomly allocated to receive either TXA or a placebo. The primary outcome is the blood transfusion rate from patient admission to the emergency department until discharge, while the secondary outcomes include: the preoperative, perioperative and postoperative haemoglobin and haematocrit levels; the preoperative and postoperative occult and total blood loss; the mean length of hospital stay; and any adverse events assessed for up to 1 year after patient discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Basque Country Ethics Committee (Ref.: 2021012) and the Spanish Agency for Medicines and Healthcare Products (Agencia Espa\u00f1ola de Medicamentos y Productos Sanitarios). All participants will provide their written informed consent prior to study inclusion. The trial\u2019s results, regardless of its outcomes, will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals, and they will be made publicly available through the European Union Clinical Trials Register after the end of the clinical trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration numbers<\/jats:title>\n                    <jats:p>EudraCT Number 2020-002144-23; EUCT Number 2024-519349-31-00.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108380","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:05:28Z","timestamp":1781265928000},"page":"e108380","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Randomised, double-blind clinical trial protocol to evaluate whether early and perioperative tranexamic acid administration reduces transfusion rates and blood loss of patients undergoing hip fracture surgery in Spain"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7403-8268","authenticated-orcid":false,"given":"Josu","family":"Arrieta","sequence":"first","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Cirug\u00eda Ortop\u00e9dica, Hospital de Zum\u00e1rraga, Zumarraga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4230-4876","authenticated-orcid":false,"given":"Gaspar","family":"De La Herran","sequence":"additional","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Cirug\u00eda Ortop\u00e9dica, Hospital Universitario de Donostia, San Sebasti\u00e1n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7334-3456","authenticated-orcid":false,"given":"Luis Angel","family":"M\u00ednguez Cabeza","sequence":"additional","affiliation":[{"name":"Servicio de Traumatolog\u00eda y Cirug\u00eda Ortop\u00e9dica, Hospital Universitario Araba, Vitoria-Gasteiz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6847-5712","authenticated-orcid":false,"given":"Mar\u00eda Isabel","family":"Fern\u00e1ndez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Servicio de Farmacia, Hospital de Zum\u00e1rraga, Zumarraga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6501-0864","authenticated-orcid":false,"given":"Mar\u00eda Teresa","family":"Revilla Guarinos","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n Cl\u00ednica, Biogipuzkoa Instituto de Investigaci\u00f3n Sanitaria, San Sebasti\u00e1n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026061205050760000_16.6.e108380.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4"},{"key":"2026061205050760000_16.6.e108380.2","doi-asserted-by":"publisher","DOI":"10.1007\/PL00004148"},{"key":"2026061205050760000_16.6.e108380.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.10.051"},{"key":"2026061205050760000_16.6.e108380.4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00068-015-0556-2","article-title":"Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients","volume":"43","author":"Heyes","year":"2017","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026061205050760000_16.6.e108380.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-019-1099-x","article-title":"Blood management in hip fractures; are we leaving it too late? 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