Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Abstract

The use of tranexamic acid (TXA) for reducing blood loss in intertrochanteric fracture (IF) surgery remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TXA in reducing transfusion requirements and blood loss for IF surgery. Databases, including PubMED, Cochrane, and Embase, were searched for RCTs that were published before February 2018 and that addressed the efficacy and safety of TXA in patients who underwent IF surgery. A total of 746 patients from 7 RCTs were subjected to meta-analysis. The results showed that TXA group had reduced surgical blood loss (weighted mean difference [WMD] = -37.24, 95% confidence interval [CI]: -48.70 to -25.77, P <.00001), reduced total blood loss (WMD = -199.08, 95% CI: -305.16 to -93.01, P = .0002), higher postoperative hemoglobin (WMD = 0.46, 95% CI: 0.12 to 0.79, P = .007), and hematocrit levels (WMD = 1.55, 95% CI: 0.64 to 2.47, P = .008) compared to control group, while no significant differences were found in transfusion rates (relative risk [RR] = 0.75, 95% CI: 0.50 to 1.11, P = .15), postoperative drainage (WMD = -38.82, 95% CI: -86.87 to 9.22, P = .11), and thromboembolic events (RR = 0.94, 95% CI: 0.41 to 2.19, P = .89). In patients undergoing IF surgery, the administration of TXA significantly reduced surgical blood loss and total blood loss, while it had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events. Nevertheless, due to the variations in the included studies, additional RCTs are required to further validate these conclusions.

Tranexamic acid in non-traumatic intracranial bleeding: a systematic review and meta-analysis

“…However, classification grades have been clustered in the meta-regression that did not find any effect. We did not study the adverse effect of TXA because many studies recently published proved its safety under many conditions, such as melasma in 2017 41 , obstetric in 2018 42 , orthopedic surgery in 2018 43 , craniomaxillofacial surgery in 2016 44 , and pre-hospital traumatic hemorrhagic shock in 2016 44 .…”

Comparison of topical and intravenous Tranexamic acid for high tibial osteotomy

“…A meta-analysis study including 746 patients found that TXA use could reduce the probability of blood transfusion by 17% and decrease the risk of perioperative complications in hip fracture surgery. [ 16 ] A placebo-controlled study including 10096 patients found TXA can reduce the early risk of bleeding and all-cause mortality in trauma patients. [ 17 ] A clinical systematic review of 1764 women undergoing caesarean delivery found that the prophylactic use of TXA could decrease blood loss and blood transfusion without increasing the risk of vascular occlusion complications.…”

Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA

“…(3) eligibility for intertrochanteric fracture surgery using the PFNA system, as determined by the senior orthopaedic surgeon. Exclusive criteria were (1) allergy to TXA or low-molecular weight heparin; (2) old, multiple or pathological fractures; (3) severe dysfunction of heart, lung, liver, kidney or coagulation; (4) anticoagulant therapy such as antiplatelet drugs or warfarin before operation; (5) recent or ongoing thromboembolic events include deep venous thrombosis, pulmonary embolism, arterial thrombosis, cerebral thrombosis, or stroke; (6) follow-up less than 1 month. A total of 218 patients were enrolled, 82 patients were administered topical TXA (study group) and 136 patients were not administered topical TXA during PFNA.…”

“…Proximate femoral nail annotation (PFNA) has become a routine fixation method for treating senile intertrochanteric fractures with the advantages of minimally invasive, simple operation and less intraoperative blood loss [3,4]. Compared to femoral neck fractures, patients with intertrochanteric fracture incur hidden blood loss and thus more often require blood transfusion [5]. Excessive postoperative bleeding would cause needs of blood transfusion, which is accompanied by risks of hypersensitivity, haemolytic reaction, cardiovascular dysfunction, infectious diseases and rejection [6,7].…”