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BACKGROUND: At present, there is no consensus and guideline for balanced hemostasis and anticoagulation in elderly patients with intertrochanteric fractures. There are few related literatures on the perioperative hemostasis and anticoagulation management of tranexamic acid combined with rivaroxaban in elderly patients with intertrochanteric fractures. OBJECTIVE: To investigate the effects of tranexamic acid combined with rivaroxaban on perioperative hemorrhage, blood transfusion, postoperative venous thrombosis in elderly patients with intertrochanteric fractures. METHODS: Sixty elderly patients with intertrochanteric fractures were enrolled and scheduled to undergo proximal femoral nail anti-rotation surgery. All patients received rivaroxaban 10 mg/d anticoagulant until 24 hours before operation. All patients were divided into two groups. Patients in the test group were intravenously injected with 1.0 g of tranexamic acid. Patients in the control group were intravenously injected with the same volume of glucose solution. Surgical blood loss, blood transfusion, and venous thrombosis prior to discharge were compared in the two groups. RESULTS AND CONCLUSION: (1) The blood loss in the test group was significantly lower than that in the control group (P < 0.05). There was no significant difference in venous thrombosis before discharge between the two groups. (2) Three patients in the test group received blood transfusions, and seven patients in the control group received blood transfusions. (3) The results confirm that tranexamic acid combined with rivaroxaban not only reduces perioperative blood loss in elderly patients with intertrochanteric fractures, but also does not increase the risk of venous thrombosis. [ABSTRACT FROM AUTHOR]