Efficacy and safety of tranexamic acid in hip fracture surgery. How does dosage affect outcomes: A meta-analysis of randomized controlled trials

Masouros, Panagiotis; Antoniou, Georgia; Nikolaou, Vasileios S.

doi:10.1016/j.injury.2021.09.063

Cited by 15 publications

(17 citation statements)

References 38 publications

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“…Finally, six high-quality randomized controlled studies [17-20, 25, 26] were included in our study. The results of the meta-analysis showed that intravenous application of TXA to intramedullary nailing in geriatric patients with intertrochanteric fractures was effective in reducing TBL, IBL, and HBL, decreasing transfusion rates and transfusion units, and not increasing thrombotic events or mortality, which were consistent with previous studies [21][22][23]27].…”

Section: Discussionsupporting

confidence: 87%

“…There was no difference in thrombotic risk and mortality. A meta-analysis by Masouros [22] included 10 randomized controlled studies containing 1123 cases to evaluate the role of intravenous TXA in hip fractures in the elderly. The results concluded that TXA was found to be effective in reducing TBL, transfusion ratio, and transfusion units without increasing the risk of thrombotic events.…”

Section: Discussionmentioning

confidence: 99%

“…TXA has been utilized in intramedullary xation for the treatment of intertrochanteric fractures, according to some studies from recent years [17][18][19][20]. On the ndings of these studies, several meta-analyses have also been published [21][22][23]. These meta-analyses, however, were clinically heterogeneous due to various TXA application methods and doses, various fracture types and surgical options, and various methods of outcome evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Zhang

Fan

Zheng

et al. 2023

Preprint

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Background: Recently, several meta-analyses on the use of tranexamic acid in intertrochanteric fractures have been published. However, their inclusion criteria were not rigorous enough, and the clinical heterogeneity was high, leading to less reliable results. Therefore, we used more stringent criteria to include the most recent randomized controlled studies. The aim was to evaluate the effects and safety of intravenous application of tranexamic acid in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing. Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) published from the database inception to August 2022. The date of total blood loss (TBL), intra-operative blood loss (IBL), hidden blood loss (HBL), transfusion rate, transfusion units, thromboembolic events, and mortality were extracted. Review Manager 5.3 was used for the analysis. Results: A total of six RCTs involving 689 patients were included. Meta-analyses indicated that TXA can significantly reduce TBL (WMD = -232.82; 95% CI -312.81 to -152.84; p < 0.00001), IBL (WMD = -36.33; 95% CI -51.38 to -21.28; p < 0.00001), HBL (WMD = -189.23; 95% CI -274.92 to -103.54; p < 0.0001), transfusion rate (RR = 0.53; 95% CI 0.33 to 0.85; p = 0.008), and transfusion units (WMD = -0.58; 95% CI -0.75 to -0.41; p < 0.01). No increase in thromboembolic events rate (RR = 0.75; 95% CI 0.38 to 1.50; p = 0.42) and mortality (RR = 1.36; 95% CI 0.61 to 3.04; p = 0.45) was observed. Conclusions: Our meta-analysis suggested that intravenous administration of TXA in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing is effective and safe. TXA resulted in a significant reduction in TBL, IBL, HBL, transfusion rate and units, without increasing the risk of thromboembolic events and mortality.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Zhang

Fan

Zheng

et al. 2023

Preprint

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“…The use of TXA in hip fractures has been the subject of several recent meta-analyses. [ 19 , 20 ] TXA was discovered to be beneficial when administered intravenously in lowering IBL, HBL, and TBL. It was also found to decrease transfusion rates and volumes without increasing operating time, thrombotic events, or mortality.…”

Section: Discussionmentioning

confidence: 99%

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis

et al. 2023

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Background: Numerous studies have demonstrated that the use of tranexamic acid (TXA) intravenously minimizes bleeding, lowers transfusion rates, and does not raise the risk of complications during major orthopedic surgery. Concerning the effectiveness of the topical application, there are, nevertheless, inconsistent findings. We aimed to develop a protocol for systematic review and meta-analysis on the benefits and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly. Methods: PubMed, Embase, and the Cochrane Library will all be searched for randomized controlled trials published from the database inception to October 15, 2022. The primary outcomes will be intraoperative blood loss, hidden blood loss, total blood loss, transfusion rate, transfusion units, operative time, thromboembolic events, and mortality. The risk of bias will be evaluated using the Cochrane risk of bias assessment tool. Review Manager 5.3 will be used for the analysis. Results: The effects and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly will be quantified in this study. Conclusions: The study’s findings will assist doctors in determining if topical TXA use is secure and efficient.

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“…A meta-analysis by Masouros et al demonstrated that higher doses of TXA did not increase the risk of adverse events significantly, but also stated that lower doses of TXA were sufficient in reducing blood loss as higher doses of TXA. 58 Two studies examined the inflammatory effect of a high initial dose of TXA and found an effect in total knee arthroplasty patients 39 but not in pediatric craniosynostosis patients. 33 Based on this review, the administration form (oral, intravenous, or topical) for TXA is not crucial for the antiinflammatory effect; however, evidence is sparse.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Okholm

Krog

Hvas

2022

Semin Thromb Hemost

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Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood loss in patients with major bleedings. Animal and cell studies have shown that TXA might modulate the inflammatory response by either enhancing or inhibiting cytokine levels. Furthermore, recent human studies have found altered inflammatory biomarkers in patients receiving TXA when compared with patients who did not receive TXA. In this systematic review we investigated the effect of TXA on inflammatory biomarkers in different patient groups. A systematic literature search was conducted on the databases PubMed and Embase to identify all original articles that investigated inflammatory biomarkers in patients receiving TXA and compared them to a relevant control group. The review was performed according to the PRISMA guidelines, and the literature search was performed on November 29, 2021. Thirty-three studies were included, among which 14 studies compared patients receiving TXA with patients getting no medication, another 14 studies investigated different dosing regimens of TXA, and finally five studies examined the administration form of TXA. The present review suggests that TXA has an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated by decreased levels of C-reactive protein and interleukin-6 in patients receiving TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis patients. The inflammatory response was not affected by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory effect of TXA was consistently found among orthopaedic patients only.

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Efficacy and safety of tranexamic acid in hip fracture surgery. How does dosage affect outcomes: A meta-analysis of randomized controlled trials

Cited by 15 publications

References 38 publications

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis

Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

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