Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis

Abstract

Background:Patients undergoing hip fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease blood loss and transfusion rates in joint replacement surgery. Therefore, we conducted a meta-analysis to evaluate efficacy and safety of intravenous TXA administration in patients suffering from hip fractures.Methods:Electronic databases were searched before December 2016 by 2 independent reviewers, including Cochrane Library, EMBASE, PubMed, Web of Science, the Chinese Biomedical Literature database, and the China National Knowledge Infrastructure databases. Randomized controlled trials (RCTs) involving the efficacy and safety of intravenous (IV) TXA in patients who underwent hip surgery were included in our meta-analysis. The endpoints included total blood loss, hidden blood loss, postoperative hemoglobin decline, transfusion rates, the rate of thrombotic events, and operative time. Current meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out using STATA V.12.0 software.Result:Eight RCTs were included, involving 598 participants. Current meta-analysis indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = −277, 95%CI: −335 to −220, P = .000), less hidden blood loss (WMD = −246, 95%CI: −252 to −241, P = .000), lower postoperative hemoglobin decline (WMD = −1.36, 95% CI: −1.84 to −0.88, P = .000), and lower transfusion rates (risk difference [RD] = −0.19, 95% CI: −0.27 to −0.11, P = .000) compared to the control group. No significant differences were found regarding the rate of thrombotic events (RD = 0.02, 95% CI: = −0.01 to 0.05, P = .262) and operative time (WMD = −0.7, 95% CI: −3.3 to 1.9, P = .6).Conclusion:It was well established that systemic administration of TXA could reduce blood loss and transfusion rates in hip fracture surgery. But the optimal regimen, dosage, and timing still need a further research. In addition, more large and high-quality randomized controlled studies are needed to focus on the safety of IV TXA application before its wide recommendation for use in hip fracture surgery.

Efficacy and safety of perioperative tranexamic acid in elderly patients undergoing trochanteric fracture surgery: a randomised controlled trial

“…In our study, no statistically significant differences were found between the TXA and placebo groups for incidence of wound complications, thromboembolic events, or mortality after 6 months' follow-up (Table 3). Our results were in accordance with the systematic reviews of Farrow et al 38 and Zhang et al, 33 which indicated that TXA did not increase the risk of wound complications, thromboembolic events, or mortality.…”

“…These results are consistent with those of previous studies. 33,34 Gausden et al 35 and Schiavone et al 36 reported significant reductions in transfusion rates with TXA use versus placebo. In the TXA in Hip Fracture Surgery study, Zufferey et al 17 also reported the same trend with a 30% relative reduction in transfusion rates with TXA administration.…”

Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis

“…7 of the questions were considered high quality, between 4 and 7 were moderate quality, and "yes" for 4 questions were low quality. 27 Additionally, the quality assessment of the observational studies was performed with the methodological items for nonrandomized studies (MINORS) criteria, with the various questions scored on a scale of 0 to 2, where a score of 16 for noncomparative and 24 for comparative studies was considered to be ideal, or high quality. 28…”

Clinical application of auricular point sticking in perioperative hemostasis for elderly patients with intertrochanteric fractures of the femur

“…[8,9] Studies have further employed this homeostatic nature of tranexamic acid to reduce blood loss and transfusion rates in patients with intertrochanteric fracture undergoing PFNA. [10–13]…”