The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA

Tian, Shuwei; Shen, Zheyuan; Yang, Lei; Zhang, Yanlong; Peng, Aqin

doi:10.1016/j.injury.2018.01.026

Cited by 70 publications

(102 citation statements)

References 29 publications

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“…The search yielded 235 unique results. Following full-text screening, 10 studies were deemed appropriate for inclusion in this study [13][14][15][16][17][18][19][20][21][22] (refer Figure 1). All trials had a predetermined transfusion protocol and these also differed ( Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

Haj-Younes

Sivakumar

Wang

et al. 2019

J Orthop Surg (Hong Kong)

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Aims: The primary objective of this review was to determine whether tranexamic acid (TXA) reduces transfusion rates in patients undergoing surgery for hip fractures. The secondary objective was to assess the effects of TXA on mortality and thromboembolic events in the same cohort. Methods: A systematic review of electronic databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials comparing perioperative TXA in patients treated surgically for hip/proximal femoral fractures against placebo. The primary outcome was the proportion of patients requiring blood transfusion. Secondary outcomes were blood loss, mortality, and complications. Meta-analysis was performed using inverse variance and random effects model. Results: The pooled data from 10 studies involving 842 patients showed that the proportion of patients requiring blood transfusion was significantly less in the TXA group (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.59–0.88). There was no difference between TXA and control groups when comparing mortality (RR 1.17, 95% CI 0.65–2.10), deep venous thrombosis (RR 1.14, 95% CI 0.43–3.06), pulmonary embolism (RR 0.53, CI 0.09–3.02), acute coronary syndrome (RR 1.52, CI 0.18–12.98), cerebrovascular events (RR 0.78, CI 0.16–3.68), or wound complications (RR 1.61, CI 0.51–5.13). Conclusion: There is evidence that TXA reduces the proportion of patients requiring blood transfusions when undergoing hip fracture surgery. However, the small sample size and low event rates for adverse effects preclude any definitive conclusions from being established regarding adverse effects. Future trials should be powered to further assess potential complications and determine the ideal dosage and regime.

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Section: Search Resultsmentioning

confidence: 99%

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

Haj-Younes

Sivakumar

Wang

et al. 2019

J Orthop Surg (Hong Kong)

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“…The mean rate of transfusion (26.1%) and mean estimated blood loss (567 mL) in the current study are similar to those in previous reports about surgical treatment of trochanteric fractures (DHS or PFNA). 29,30 Older patients have lower preoperative Hb values, and older age and intramedullary nail osteosynthesis both increase the risk of erythrocyte transfusion. 17 This study design accounted for this major confounder through stratification of randomisation by age.…”

Section: Discussionmentioning

confidence: 99%

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

Jiang

et al. 2019

Hong Kong Med J

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Trochanteric fractures result in a high frequency of considerable blood loss, a high incidence of blood transfusions, and a high risk of perioperative morbidity and mortality in elderly patients. This study aimed to evaluate the efficacy and safety of a three-dose regimen of tranexamic acid on blood loss and transfusion rate in elderly patients with trochanteric fractures. Methods: Eligible patients with trochanteric fractures surgically treated by dynamic hip screw and proximal anti-rotating intramedullary nail between March 2016 and October 2017 were enrolled in the study. Patients were randomly assigned to receive 15 mg/kg intravenous tranexamic acid dissolved in 100 mL of saline (TXA group) or 100 mL of saline solution (placebo group) over 10 minutes before, during, and after surgery. Perioperative blood loss, obvious blood loss, and hidden blood loss in the two groups were calculated separately. Vascular events and patient mortality over 6 months' follow-up were noted. Results: In total, 176 patients were included. Compared with the placebo group (n=88), patients

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“…A few literatures showed that the postoperative hidden blood loss is more than intra-operative blood loss. [45][46][47] Unfortunately, this presented meta-analysis didn't analyze the hidden blood loss. Therefore, only analyzing intraoperative blood loss may be unfair for the AR group.…”

Section: Operative Time Blood Loss and Transfusionmentioning

confidence: 99%

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Yu¹,

Lu²,

Xiao³

et al. 2020

Preprint

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Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA

Cited by 70 publications

References 29 publications

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

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

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

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