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

Abstract

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.

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

“…It possesses great potential in reducing blood loss and allogeneic blood transfusion safely in patients with hip fractures undergoing surgery. Five meta-analyses [ 116 , 117 , 118 , 119 , 120 ] of RCTs comparing intraoperative administration of TXA with placebo in patients undergoing hip fracture surgery showed significant differences between groups regarding transfusion rates of allogeneic blood, total blood loss, intraoperative blood loss, postoperative blood loss and postoperative haemoglobin, without affecting the rates of thromboembolic events, deep venous thrombosis, acute coronary syndrome, cerebrovascular events, wound complications or mortality.…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…It possesses great potential in reducing blood loss and allogeneic blood transfusion safely in patients with hip fractures undergoing surgery. 5 meta-analyses [115][116][117][118][119] of RCTs comparing intraoperative administration of TXA with placebo in patients undergoing hip fracture surgery showed significant differences between groups regarding transfusion rates of allogeneic blood, total blood loss, intraoperative blood loss, postoperative blood loss and postoperative haemoglobin, without affecting the rates of thromboembolic events, deep venous thrombosis, acute coronary syndrome, cerebrovascular events, wound complications or mortality.…”

Study protocol for a multicentre, 2×2 factorial, randomised, controlled trial evaluating the interest of intravenous iron and tranexamic acid to reduce blood transfusion in hip fracture patients (the HiFIT study)

“… 27 Two recent meta-analyses report a significant reduction in blood transfusion using intravenous TXA in patients with HF; however, the heterogeneity is important (I 2 =60%) and the sample size is too small to evaluate the tolerance of this treatment. 28 29 In addition, use of intravenous TXA could be limited in this population of frail patients and topical use of TXA appears to be an effective and safe alternative, at least in major orthopaedic surgery patients. 30–32 It has also been reported that the combined use of intravenous and topical TXA may be superior to intravenous alone in orthopaedic surgery patients.…”