A systematic review of tranexamic acid usage in patients undergoing femoral fracture surgery

Abstract

BackgroundPatients undergoing femoral fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease transfusion rate in joint replacement surgery. Therefore, we conducted a systematic review to evaluate the efficacy and safety of TXA usage in femoral fracture surgery.Materials and methodsStudies involving TXA usage in femoral fracture surgery were searched through four electronic databases. The end points included total blood loss, postoperative hemoglobin decline, transfusion rate, thromboembolic events, 90-day mortality, and operative time. The present study was performed following Cochrane Reviewers’ Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was carried out by using Stata 14.0 software.ResultsEleven studies concerning intravenous (IV) application of TXA and three studies concerning topical administration of TXA were included. Twelve studies were randomized controlled trials (RCTs), and one was a retrospective cohort study. Regarding IV TXA, our paper indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = −319.282, P = 0.000), lower postoperative hemoglobin decline (WMD = −1.14, P = 0.000) and lower transfusion rate (risk difference [RD] = −0.172, P = 0.000). No significant differences were found in thromboembolic events (RD = 0.008, P = 0.507), 90-day mortality (RD = 0.009, P = 0.732) and operative time (WMD = −2.227, P = 0.103). Regarding topical TXA, no significant differences were found in the transfusion rate (RD = −0.098, P = 0.129), postoperative hemoglobin decline (WMD = −1.137, P = 0.231), thromboembolic events (RD = −0.017, P = 0.660) and operative time (WMD = −4.842, P = 0.136).ConclusionOur meta-analysis demonstrated that both IV and topical application of TXA reduced transfusion rate in femoral fracture surgery. However, still further studies are needed to identify the optimal route of administration, TXA dosage and timing. In addition, high-quality RCTs with a large sample size are required to figure out the safety of TXA application, especially in the elderly, before its wide recommendation.

Tranexamic acid and reduction of blood transfusion in lower limb trauma surgery: a randomized controlled study

“…This was as per protocol used by Gausden et al [20]. Zhang et al also agreed that the common methods of IV TXA usage are the immediate pre-operative doses of 1 g or 10-15 mg/kg [21]. Lanoiselée et al pointed out that TXA plasma concentrations were maintained for > 10 mg/L during surgery and for a minimum of 3 h with a pre-operative TXA dose of 1 g in hip arthroplasty [22].…”

The effects of macrolides in children with reactive airway disease: a systematic review and meta-analysis of randomized controlled trials

“…This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines ( Table S1 ). 44 We searched the following databases from inception to the end of August 2018: Embase, PubMed, and the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We used the keywords “Asthma” or “Chronic cough” or “infantile asthma” or “wheezing” or “wheez*” and “Erythromycin” or “Azithromycin” or “Zithromax” or “Clarithromycin” or “macrolide(s)” in our search.…”

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations

“… 40 These results contrasted with a meta-analysis of 13 RCTs consisting of either IV or topical routes of TXA administration in patients undergoing surgical fixation for unspecified femoral fractures which concluded that while those receiving IV TXA exhibited a significant reduction in postoperative transfusion, patients receiving topical TXA had no significant reduction in transfusion rates and postoperative hemoglobin levels. 42 A different study of 125 elderly patients with intertrochanteric fractures who received 1g of IV TXA instead reported on the degree of hidden posttraumatic blood loss and preoperative transfusion rates. The significant reduction in hidden blood loss, as determined by hemoglobin levels, as well as the reduction in preoperative transfusions in the TXA group highlights the potential of the drug in improving patient stability and reducing the likelihood of complications associated with acute trauma.…”

“… Use of TXA perioperatively in patients undergoing primary shoulder arthroplasty can decrease perioperative blood loss, change in Hgb and Hct, and postoperative drain output Trauma Zhu et al, 2018 40 ITF Meta analysis 7 RCTs 746 patients - Administration of TXA in Intertrochanteric Fracture Surgery significantly reduced surgical blood loss and total blood loss - It had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events Ma et al, 2021 41 ITF RCT 125 patients Early IV TXA intervention was shown to reduce post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis. Zhang et al, 2018 42 FF Meta analysis 12 RCTs, and one was a retrospective cohort study. Approximately 1063 patients IV and topical routes of TXA administration in patients undergoing surgical fixation for unspecified femoral fractures were both very useful in reducing the rate of blood transfusions Qi et al, 2019 43 HF Meta analysis 10 RCTs Approximately 854 patients The use of TXA in hip fracture surgery showed a significant decrease in transfusion rates without a concurrent increase in the incidence of thromboembolic events Xiao et al, 2019 44 HF Meta analysis 11 RCTs 892 patients Significant decrease in transfusion rates in the TXA group without a concurrent increase in the incidence of thromboembolic events Gausden et al, 2017 45 TRAUMA Meta analysis 12 studies 1333 patients TXA reduces the risk of blood transfusion, reduces perioperative blood loss, and has no significant effect on the risk of symptomatic thromboembolic events when u...…”