Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Abstract

Background Meta-analyses on the use of tranexamic acid (TXA) in intertrochanteric fractures have shown inconsistent results due to variations in inclusion criteria and clinical heterogeneity. To address these limitations, we conducted a rigorous analysis of recent randomized controlled trials (RCTs) with strict inclusion criteria. The aim of this study was to objectively evaluate the effects and safety of intravenous TXA administration in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing. Methods PubMed, Embase, and the Cochrane Library were searched for RCTs published from the database inception to August 2022. The date of total blood loss (TBL), intra-operative blood loss (IBL), hidden blood loss (HBL), transfusion rate, transfusion units, thromboembolic events, and mortality were extracted. Review Manager 5.3 was used for the analysis. Results A total of six RCTs involving 689 patients were included. Meta-analyses indicated that TXA can significantly reduce TBL (WMD = -232.82; 95% CI -312.81 to -152.84; p < 0.00001), IBL (WMD = -36.33; 95% CI -51.38 to -21.28; p < 0.00001), HBL (WMD = -189.23; 95% CI -274.92 to -103.54; p < 0.0001), transfusion rate (RR = 0.53; 95% CI 0.33 to 0.85; p = 0.008), and transfusion units (WMD = -0.58; 95% CI -0.75 to -0.41; p < 0.01). No increase in thromboembolic events rate (RR = 0.75; 95% CI 0.38 to 1.50; p = 0.42) and mortality (RR = 1.36; 95% CI 0.61 to 3.04; p = 0.45) was observed. Conclusions Our meta-analysis provides robust evidence supporting the efficacy and safety of intravenous TXA administration in treating geriatric intertrochanteric femoral fractures with intramedullary nailing. TXA significantly reduces blood loss and transfusion requirements without increasing the risk of thromboembolic events or mortality.

Evaluation of the Early Administration of Tranexamic Acid in Geriatric Hip Fractures in the Emergency Department: A Retrospective Study

“…In a recent study involving elderly patients who underwent hemiarthroplasty for hip fracture, TXA administration before surgery was found to be safe, with higher mean hemoglobin levels, lower rates of transfusion, and no additional risk of deep vein thrombosis compared to those who did not receive TXA [11]. Furthermore, a recent systematic review and meta-analysis found that TXA given intravenously compared to a placebo is safe and efficacious for elderly patients undergoing intramedullary nailing for intertrochanteric hip fractures [12]. Blood loss and the need for blood transfusion were lessened with no elevated risk of adverse events [12].…”

“…Furthermore, a recent systematic review and meta-analysis found that TXA given intravenously compared to a placebo is safe and efficacious for elderly patients undergoing intramedullary nailing for intertrochanteric hip fractures [12]. Blood loss and the need for blood transfusion were lessened with no elevated risk of adverse events [12]. A broader systematic review and meta-analysis compared TXA with a placebo in the elderly population before surgery and found similar benefits [13].…”