One Versus Two Doses of Tranexamic Acid in Surgically Treated Extracapsular Hip Fractures

Inclusion Criteria: * Written informed consent obtained * Patients aged 65 years or older * Patients with pertrochanteric femoral fracture (AO/OTA classification: 31A1.2, 31A1.3, 31A2, 31A3) or subtrochanteric femoral fracture (AO/OTA classification: 32; fractures from the level of the lesser trochanter to 5 cm distally) * Surgical treatment performed within 48 hours of hospital admission Exclusion Criteria: * Age younger than 65 years * Known allergy or hypersensitivity to tranexamic acid * Active thromboembolic event (deep vein thrombosis, arterial thrombosis, pulmonary embolism) or history of vascular event within the past year (myocardial infarction, coronary or peripheral vascular stenting, thromboembolism, stroke) * Impaired renal function defined as serum creatinine \>120 µmol/L in the last preoperative laboratory test * History of malignant disease * History of seizure disorder or chronic anticonvulsant therapy * Polytrauma or multiple trauma * More than one fracture * Previous fracture of the same hip * Preoperative hemoglobin level \<8 g/dL (last laboratory test before surgery) * Thrombocytopenia or other coagulation disorders * Treatment with vitamin K antagonists with INR \>1.5 * Treatment with low-molecular-weight heparins without appropriate preoperative discontinuation according to clinical protocol (usually ≥24 hours for prophylactic doses and ≥24-36 hours for therapeutic doses) * Treatment with direct oral anticoagulants without appropriate preoperative discontinuation (usually 24-48 hours, depending on renal function and bleeding risk) * Treatment with P2Y12 inhibitors (e.g., ticagrelor, clopidogrel, prasugrel) when, according to anesthesiologist assessment, surgery cannot be safely performed within 48 hours