Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

Salameh, Motasem; Attia, Ahmed Khalil; Khatib, Suhaib El; Hantouly, Ashraf T.; Hsu, Raymond Y.; Blankenhorn, Brad D.

doi:10.1177/10711007221114139

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…TXA is capable of binding to plasminogen and preventing tissue-type plasminogen activator (t-PA)-mediated release of active plasmin via the prevention of plasminogen binding to fibrin via lysine-binding sites [ 19 , 20 ]. In our study, we found that the administration of TXA significantly reduced the postoperative blood loss (as we consider postoperative drainage can be regarded as invisible postoperative bleeding and confirmed the previous studies) in the first 24 h, whereas there was no difference in the total volume or those after 24 h. Our results are like previous studies [ 20 – 23 ], and relevant reasons are that TXA has a half-life of 2 h, and the effects are strongest in the first 24 h and begin to weaken over the subsequent time.…”

Section: Discussionsupporting

confidence: 92%

The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trials

Tang

Zheng

et al. 2023

J Orthop Surg Res

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Background Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, delaying fibrinolysis and blood clot degradation. However, the effect of TXA on patients with calcaneal surgery remains controversial. Our objective was to evaluate the effectiveness of TXA in calcaneal fractures surgeries. Methods The electronic literature databases of Pubmed, Embase, and Cochrane library were searched in December 2022. The data on blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication were extracted. The Stata 22.0 software was used for the meta-analysis. Results Four randomized controlled studies met our inclusion criteria. This meta-analysis showed that TXA significantly reduced postoperative blood loss during the first 24 h (p < 0.001), improved the level of hemoglobin (p < 0.001) and hematocrit (p = 0.03), and reduced the risk of wound complications (p = 0.04). There was no significant difference between the two groups regarding total and intraoperative blood loss, hospital stay, duration of surgery, platelet count, activated partial thromboplastin time, and prothrombin time. Conclusion TXA significantly reduced blood loss during the first 24 h postoperatively, improved the level of hemoglobin and hematocrit, and reduced the risk of wound complications. Given the evidence, TXA can be used in patients with calcaneal fractures and had the potential benefit of blood reduction. Protocol registration The protocol was registered in PROSPERO (registration No. CRD42023391211).

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Section: Discussionsupporting

confidence: 92%

The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trials

Tang

Zheng

et al. 2023

J Orthop Surg Res

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“…However, the application of TXA in foot and ankle surgery is relatively rare [ 30 , 31 ]. Currently, few studies have shown that TXA has potential benefits in reducing blood loss and wound complications without increasing the risk of thromboembolic events [ 32 – 34 ], but there is still some controversy [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of different does of intravenous tranexamic acid on blood loss in fresh foot and ankle fractures: a prospective, randomized controlled study

Tan,

Li,

et al. 2024

BMC Musculoskelet Disord

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Background There are a few studies on the effectiveness and safety of intravenous administration of tranexamic acid(TXA) in patients who underwent foot and ankle surgery, especially for preoperative hidden blood loss in patients with freshfoot and ankle fractures. Thus, the aim of this study was to investigate whether intravenous administration of different doses of TXA can effectively reduce perioperative blood loss and blood loss before surgery and to determine its safety. Methods A total of 150 patients with fresh closed foot and ankle fractures from July 2021 to July 2023 were randomly divided into a control group (placebo controlled [PC]), standard-dose group (low-dose group [LD], 1 g/24 h; medium-dose group [MD], 2 g/24 h), and high-dose group (HD, 3 g/24 h; ultrahigh-dose group [UD], 4 g/24 h). After admission, all patients completed hematological examinations as soon as possible and at multiple other time points postsurgery. Results There was a significant difference in the incidence of hidden blood loss before the operation between the TXA group and the control group, and the effect was greater in the overdose groups than in the standard-dose groups. There were significant differences in surgical blood loss (intraoperative and postoperative), postoperative HGB changes, and hidden blood loss among the groups. The TXA groups showed a significant decrease in blood loss compared to that of the control group, and the overdose groups had a more significant effect than the standard-dose groups. A total of 9 patients in the control group had early wound infection or poor healing, while only 1 patient in the other groups had this complication, and the difference among the groups was significant. No patients in any group suffered from late deep wound infection, cardiovascular or cerebrovascular events or symptomatic VTE. Conclusion This is the first study on whether TXA can reduce preoperative hidden blood loss in patients with freshfoot and ankle fractures. In our study, on the one hand, intravenous application of TXA after foot and ankle fractures as soon as possible can reduce preoperative blood loss and postoperative blood loss. On the other hand, TXA can also lower wound complications, and over-doses of TXA are more effective than standard doses. Moreover, overdoses of TXA do not increase the incidence of DVT.

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“…It is our pleasure to thank the team of Dr Blankenhorn for performing the study titled “Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis.” 6 As a result of a similar analysis we conducted recently, 5 we have some concerns about the results reported and would like to share our opinions.…”

mentioning

confidence: 90%

Letter Regarding: Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

Mirghaderi¹,

Kachooei²

2023

Foot Ankle Int.

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Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

Cited by 9 publications

References 26 publications

The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trials

The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trials

The efficacy and safety of different does of intravenous tranexamic acid on blood loss in fresh foot and ankle fractures: a prospective, randomized controlled study

Letter Regarding: Tranexamic Acid Utilization in Foot and Ankle Surgery: A Meta-analysis

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