The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

Abstract

ObjectiveThe present meta-analysis was conducted to compare the efficacy and safety of intravenous application of tranexamic acid (TXA) with placebo in patients with hip fracture undergoing hip surgeries.MethodsPubMed, EMBASE and Cochrane Library were searched from inception until March 2018. A combined searching strategy of subject words and random words was adopted. Only randomized clinical trials were included. The comparisons regarding transfusion rate, total blood loss, intraoperative blood loss, postoperative blood loss, postoperative haemoglobin and postoperative thromboembolic complications were conducted. The meta-analysis was performed using Review Manager 5.3, and the bias evaluation was based on the Cochrane Handbook 5.1.0.ResultsTen randomized controlled trials published from 2007 to 2018 were included in the meta-analysis. The results showed that there were significant differences in the two groups concerning transfusion rate of allogeneic blood [risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.56 to 0.78, P = 0.003], total blood loss [mean difference (MD) = −273.00, 95% CI: −353.15 to −192.84, P < 0.00001], intraoperative blood loss (MD = −76.63, 95% CI: −139.55 to −13.71, P = 0.02), postoperative blood loss (MD = −125.29, 95% CI: −221.96 to −28.62, P = 0.01) and postoperative haemoglobin (MD = 0.80, 95% CI: 0.38 to 1.22, P = 0.0002). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 1.38, 95% CI: 0.74 to 2.55, P = 0.31).ConclusionsThis meta-analysis of the available evidence implies that the intravenous route of TXA shows an ability to reduce transfusion requirements and total blood loss, not increasing the incidence of thromboembolic events in patients undergoing hip surgeries.The translational potential of this articleThe result of this meta-analysis shows that the utilization of intravenous TXA in patients with hip fracture undergoing hip surgeries possesses great potential in reducing blood loss and allogeneic blood transfusion safely.

Anemia at Presentation Predicts Acute Mortality and Need for Readmission Following Geriatric Hip Fracture

“…There is compelling evidence suggesting that the intraoperative administration of TXA reduces transfusion rates and bleeding complications in arthroplasty patients 44 , 45 . The benefit of TXA appears to also apply to hip fracture patients 41 , 42 , 46 , 47 ; however, additional research is required to fully elucidate this with respect to preoperative anemia and is outside the scope of this study.…”

Tranexamic Acid Combined with Compression Bandage Following Total Knee Arthroplasty Promotes Blood Coagulation: A Retrospective Analysis

“…These results were consistent with previous reports. In previous reports, intravenous TXA can increase the postoperative Hb level of patients with TKA, reduces the trend of postoperative blood loss, and does not cause thrombus [ 14 , 15 ].…”

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

“…Nonetheless, nowadays more and more geriatric patients are suffering from hip fractures, for some of them it may be better to receive THA [39]. Qi et al [40] demonstrated that intravenous TXA reduced total blood loss and transfusion requirements, but did not increase the incidence of thromboembolic events in patients who suffered from hip fractures and underwent THA . Although Tranexamic acid was discovered more than 50 years ago, the clinical utilization of tranexamic to reduce blood loss and transfusion requirements became popular in the past decade.…”