Topical administration of tranexamic acid in elderly patients undergoing short femoral nailing for intertrochanteric fracture: A randomised controlled trial

Yee, Dennis Kh; Wong, Janus Siu Him; Fang, Evan; Wong, Tak-Man; Fang, Christian; Leung, Frankie

doi:10.1016/j.injury.2021.11.055

Cited by 10 publications

(16 citation statements)

References 42 publications

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“…Through reading the full text, fourteen studies were excluded because of irrelevant to our topic, no relevant data, non-English publications, and ongoing clinical research that has not yet been published. Finally, nine RCTs ( Drakos et al, 2016 ; Tengberg et al, 2016 ; Lei et al, 2017 ; Schiavone et al, 2018 ; Tian et al, 2018 ; Luo et al, 2019 ; Zhou et al, 2019 ; Yee et al, 2022 ; Zhang et al, 2022 ), including nine hundred and seventy-two participants, met the selection criteria and were enrolled in this study. The flow diagram of this study is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The main characteristics and surgical information among the nine enrolled RCTs are shown in Table 1 and Table 2 , respectively. Among these enrolled studies, six studies were conducted in China ( Lei et al, 2017 ; Tian et al, 2018 ; Luo et al, 2019 ; Zhou et al, 2019 ; Yee et al, 2022 ; Zhang et al, 2022 ), each one in Greece ( Drakos et al, 2016 ), Italy ( Schiavone et al, 2018 ) and Denmark ( Tengberg et al, 2016 ). The published years of enrolled RCTs were between 2016 and 2022.…”

Section: Resultsmentioning

confidence: 99%

“…The published years of enrolled RCTs were between 2016 and 2022. Among these included studies, two studies utilized TXA by local administration ( Drakos et al, 2016 ; Yee et al, 2022 ), and the other studies utilized TXA by intravenous administration ( Tengberg et al, 2016 ; Lei et al, 2017 ; Schiavone et al, 2018 ; Tian et al, 2018 ; Luo et al, 2019 ; Zhou et al, 2019 ; Zhang et al, 2022 ). The fracture type classified by the American Orthopedic/Orthopedic Trauma Association, ranges from 31 A1 to A3.…”

Section: Resultsmentioning

confidence: 99%

“…Low molecular weight heparin was used to prevent thromboembolic events in six studies ( Drakos et al, 2016 ; Tengberg et al, 2016 ; Tian et al, 2018 ; Luo et al, 2019 ; Zhou et al, 2019 ; Zhang et al, 2022 ). Five studies screened all patients for thromboembolic events such as deep vein thrombosis postoperatively ( Lei et al, 2017 ; Schiavone et al, 2018 ; Tian et al, 2018 ; Luo et al, 2019 ; Zhang et al, 2022 ), and the other studies performed further imaging and laboratory examination when patients presented with clinical symptoms ( Drakos et al, 2016 ; Tengberg et al, 2016 ; Zhou et al, 2019 ; Yee et al, 2022 ). The procedures for surgery were described in detail in all included studies.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, TXA can effectively reduce the amount of bleeding and has been widely used in spine, shoulder, hip, and knee surgery ( Hartland et al, 2021 ; Ling et al, 2021 ). Recently, more and more researchers applied TXA to reduce perioperative blood loss in the treatment of intertrochanteric fracture patients undergoing intramedullary fixation surgery ( Zhou et al, 2019 ; Yee et al, 2022 ; Zhang et al, 2022 ). However, a major limitation of all these trials is the sample size, which may lead to underpowered conclusions.…”

Section: Introductionmentioning

confidence: 99%

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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

Jiang

Xing²,

Zhe³

et al. 2022

Front. Pharmacol.

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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]

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Jiang

Xing²,

Zhe³

et al. 2022

Front. Pharmacol.

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Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

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Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

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Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial

Luo,

Peng,

Zhou

et al. 2024

Chinese Journal of Traumatology

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Topical administration of tranexamic acid in elderly patients undergoing short femoral nailing for intertrochanteric fracture: A randomised controlled trial

Cited by 10 publications

References 42 publications

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

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

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial

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