Use of Tranexamic Acid in Dynamic Hip Screw Plate Fixation for Trochanteric Fractures

Baruah, Ranjit Kumar; Borah, Pranab Jyoti; Haque, Russel

doi:10.1177/1602400322

Cited by 37 publications

(42 citation statements)

References 12 publications

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“…Ten studies 18 – 21 , 23 , 25 , 26 , 28 – 30 were of high quality, and two studies were of moderate quality. 24 , 27 The randomization methods were explicitly introduced in nine studies. 18 – 20 , 23 , 25 , 26 , 28 – 30 Randomization allocation was concealed adequately in six studies.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies 18 , 24 , 26 , 29 compared total blood loss. The data of them were pooled to do analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Seven articles 18 , 20 – 24 , 28 reported the outcome of postoperative hemoglobin decline. A significant heterogeneity was detected between the studies ( P < 0.1, I 2 = 75.4%).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies 19 – 24 , 26 , 29 , 30 reported thromboembolic events. No significant heterogeneity was detected ( P > 0.1, I 2 = 9.0%), so the fixed-effects model was performed.…”

Section: Resultsmentioning

confidence: 99%

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

Zhang¹,

Bai²,

He³

et al. 2018

CIA

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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.

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Section: Resultsmentioning

confidence: 99%

“…Four studies 18 , 24 , 26 , 29 compared total blood loss. The data of them were pooled to do analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Seven articles 18 , 20 – 24 , 28 reported the outcome of postoperative hemoglobin decline. A significant heterogeneity was detected between the studies ( P < 0.1, I 2 = 75.4%).…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies 19 – 24 , 26 , 29 , 30 reported thromboembolic events. No significant heterogeneity was detected ( P > 0.1, I 2 = 9.0%), so the fixed-effects model was performed.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Zhang¹,

Bai²,

He³

et al. 2018

CIA

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“…More recently, TXA has been advocated for routine prophylactic use during gynecologic surgery [7], [8], orthopaedic lower limb joint replacement surgery [9], [10], and emergency orthopaedic hip surgery [11].…”

Section: Introductionmentioning

confidence: 99%

Primary lower limb joint replacement and tranexamic acid: an observational cohort study

et al. 2018

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BackgroundThis work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery.MethodsThis retrospective cohort study included all primary hip or knee replacement procedures by a single surgeon over a 6-year period. TXA was introduced during the study period as part of an enhanced recovery after surgery strategy.ResultsOf the 673 procedures, 446 cases (66.3%) received TXA. The median length of stay was 5 days (2-69) and 6 days (3-28) for the TXA and control groups, respectively (P < .001). Blood transfusion was required for 28 (6.3%) of the TXA cases versus 40 (17.6%) controls (P < .001). Complication rates were similar irrespective of TXA status. At multivariate analysis, TXA was significantly and independently associated with fewer blood transfusions (hazard ratio 0.309, 95% confidence interval: 0.168-0.568, P < .001), with a number needed to treat of 9 cases. TXA use was estimated to save between £67.89 and £155.90 per case.ConclusionsRoutine prophylactic TXA administration for elective primary hip and knee replacement reduces the likelihood of postoperative transfusion with a number needed to treat of 9. Cost savings may be as high as £155.90 per case, and no safety concerns were noted.

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Use of Tranexamic Acid in Dynamic Hip Screw Plate Fixation for Trochanteric Fractures

Abstract: TXA is safe and effective in reducing blood loss in dynamic hip screw plate fixation for stable trochanteric fractures.

Cited by 37 publications

References 12 publications

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

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

Primary lower limb joint replacement and tranexamic acid: an observational cohort study

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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