Efficacy and safety of tranexamic acid for patients with intertrochanteric fractures treated with intramedullary fixation: A systematic review and meta-analysis of current evidence in randomized controlled trials

Abstract

Background: Tranexamic acid (TXA) has been widely applied to reduce perioperative bleeding. Recently, several studies focused on the administration of TXA in the treatment for with intertrochanteric fracture patients treated with intramedullary fixation. However, the efficacy and safety of TXA in these studies remain controversial. Therefore, we performed this systematic review and meta-analysis to investigate the efficacy and safety of TXA in intertrochanteric fracture patients treated with intramedullary fixation.Methods: We systematically searched electronic databases, including Cochrane, PubMed, and EMBASE, up to 16 May 2022. The efficacy and safety of TXA was evaluated in four aspects, which were bleeding-related outcomes, non-bleeding-related outcomes, thromboembolic events, and other complications. The outcomes of these studies were extracted and analyzed by RevMan Manager 5.4.Results: Finally, nine randomized controlled trials, involving nine hundred and seventy-two intertrochanteric fracture patients treated with TXA, were enrolled in this study. In the bleeding-related outcomes, TXA group was significantly lower than the control group in terms of total blood loss (MD = −219.42; 95% CI, −299.80 to −139.03; p < 0.001), intraoperative blood loss (MD = −36.81; 95% CI, −54.21 to −19.41; p < 0.001), hidden blood loss (MD = −189.23; 95% CI, −274.92 to −103.54; p < 0.001), and transfusion rate (RR = 0.64; 95% CI, 0.49 to 0.85; p = 0.002). Moreover, the postoperative hemoglobin on day 3 of the TXA group was significantly higher than that of the control group (MD = 5.75; 95% CI, 1.26 to 10.23; p = 0.01). In the non-bleeding-related outcomes, the length of hospital stays was significantly shorter in the TXA group (MD = −0.67; 95% CI, −1.12 to −0.23; p = 0.003). In terms of thromboembolic events, there was no significant differences between the TXA group and control group in deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke. As for complications and mortality, there was no significant differences between the TXA group and control group in respiratory infection, renal failure, and postoperative mortality within 1 year.Conclusion: TXA is an effective and safe drug for perioperative bleeding control in intertrochanteric fracture patients treated with intramedullary fixation. However, the long-term efficacy of TXA still needs to be investigated by large-scale multicenter randomized controlled trials.Level of evidence: II, Systematic review and Meta-analysis.Systematic Review Registration:https://inplasy.com/, identifier [INPLASY202280027]

Perioperative Administration of Tranexamic Acid and Low Molecular Weight Heparin for Enhanced Blood Management in Intertrochanteric Fractures: A Randomized Controlled Study

“…Thus, administering TXA at 3-h intervals postoperatively can sustain its effective concentration for an extended period, reinforcing coagulation functions during peak blood loss periods. Zhou et al [ 10 ] and Jiang et al [ 20 ] demonstrated the clinical efficacy of TXA appliances in reducing blood loss in IF, while ignoring the possibility of perioperative multiple doses of TXA. In our study, we compared the 3 different regimens and found 4-dose TXA therapy had excellent clinical effects in reducing perioperative blood loss compared to the single-dose group and control group.…”

“…In addition, a systematic review and meta-analysis by Jiang et al investigated the efficacy and safety of TXA in IF patients treated with intramedullary fixation. The study included 9 randomized controlled trials with 972 patients, indicating that TXA significantly reduced total blood loss, intraoperative blood loss, hidden blood loss, and transfusion rate compared to the control group [ 20 ].…”

Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta-analysis

“…Recent evidence consistently advocates for the use of TXA in controlling blood loss during TJA surgery, primarily attributing postoperative blood loss to the instantaneous activation of the fibrinolytic cascade ( 22 ). TXA's mechanism of action involves preventing fibrinolysis by blocking the lysine-binding site of plasminogen, thereby displacing plasminogen from the surface of fibrin ( 23 ). This synthetic fibrinolytic inhibitor competitively inhibits plasmin, plasminogen, and fibrin from combining, directly inhibiting plasmin activity ( 24 ).…”

The Efficiency and Safety of Platelet-Rich Plasma Dressing in the Treatment of Chronic Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…PRP consists of large amounts of growth factors and cytokines, which are released onto the wound and can recruit stem cells and various kinds of growth factors via cascade reactions. These cells and factors can contribute to regulating epithelial cell proliferation and migration, regulating fibroblastic activity [ 18 ], promoting angiogenesis and vessel permeability [ 53 ], and increasing protein and extracellular matrix synthesis [ 54 ]. In vivo, these growth factors could enhance the metabolic reprogramming of fibroblasts, especially promoting their glycolytic energy metabolism, to stimulate fibroblast proliferation and differentiation during tissue repairing [ 55 ].…”