Tranexamic Acid in Pertrochanteric Femoral Fracture: Is it a Safe Drug or Not?

Schiavone, Andrea; Bisaccia, Michele; Inkov, Ivan; Rinonapoli, Giuseppe; Manni, Mattia; Rollo, Giuseppe; Meccariello, Luigi; Vicente, Cristina Ibáñez; Ceccarini, Paolo; Ruggiero, Carmelinda; Caraffa, Auro

doi:10.1515/folmed-2017-0070

Cited by 31 publications

(36 citation statements)

References 34 publications

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“…Despite the wide use of TXA, there has been concern regarding its association with increased incidence of venous thrombosis and mortality. 32 Zufferey et al 17 and Schiavone et al 36 reported a three-fold increase in vascular events (deep venous thrombosis, pulmonary embolism, cerebrovascular accident, and myocardial infarction) with intravenous TXA administration in hip fracture surgery, but this was not statistically significant. A number of metaanalyses have found no increase in thromboembolic complications but were unable to draw conclusions regarding the safety of TXA because of potential bias.…”

Section: Discussionmentioning

confidence: 99%

“…These results are consistent with those of previous studies. 33,34 Gausden et al 35 and Schiavone et al 36 reported significant reductions in transfusion rates with TXA use versus placebo. In the TXA in Hip Fracture Surgery study, Zufferey et al 17 also reported the same trend with a 30% relative reduction in transfusion rates with TXA administration.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…After a detailed evaluation, eight independent RCTs[10,23,30-35] with cumulatively 836 patients were included in the overall meta-analysis (Figure 1). Most of the RCTs were relatively well-designed and their CONSORT adherence scores ranged from 19 to 24, with a maximum score of 25.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of tranexamic acid in elderly patients with intertrochanteric fracture: An updated meta-analysis

Zhou¹,

Jin²,

Fan³

et al. 2019

WJCC

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BACKGROUND Intertrochanteric fracture (ITF) is a common type of injury, and nearly 30% of ITF patients die in the first 12 mo, especially the elderly with limited activity. Tranexamic acid (TXA) has been widely used in reducing traumatic and surgical bleeding, however, the paucity of studies regarding its use in orthopedic trauma surgery has limited its integration into this field, which may benefit most from TXA. The safety of TXA in this group has not achieved a consensus. AIM This meta-analysis was designed to investigate the efficacy and safety of TXA in elderly ITF patients undergoing surgery. METHODS Databases, including Medline and PubMed, were searched for randomized controlled trials (RCTs) that were published before October 2018 and that addressed the efficacy and safety of TXA in patients who underwent ITF surgery. The Consolidated Standards of Reporting Trials 2010 Statement Checklist was used to assess the methodological quality of each study. Trials without and with heterogeneity were compared by fixed-effects analysis and random-effects analysis, respectively. For each study, odds ratio (OR) and 95%CI and mean differences and 95%CI were calculated for dichotomous and continuous outcomes, respectively. The Power and Sample Size Program software was used to calculate power and sample size. Stability of the results was assessed via sensitivity analysis. RESULTS A total of 836 patients from eight RCTs were subjected to meta-analysis. TXA treatment compared with the control group significantly reduced postoperative blood loss (95%CI, -20.83 to -7.93 mL, P < 0.0001), hidden blood loss (95%CI, -213.67 to -64.43 mL, P = 0.0003), and total blood loss (95%CI, -332.49 to -23.18 mL, P = 0.02) by weighted mean differences of -14.38, -139.05, and -177.83 mL, respectively. However, no significant difference was observed between groups for analysis of intraoperative blood loss. The meta-analysis also proved that the usage of TXA in ITFs may not significantly increase the incidence of deep venous thrombosis. Allogeneic blood transfusion data showed that significantly fewer patients in the TXA group (42%) required transfusion than the control group (95%CI, 0.36 to 0.69; P < 0.0001). CONCLUSION In ITF surgery, intravenous administration of TXA reduces the risk of hidden blood loss and the need for allogeneic transfusion, without increasing thrombotic risk.

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“…There are studies in the literature investigating the effects of some protocols on blood loss following femoral fracture surgery. Schiavone et al reported that the use of tranexamic acid significantly decreased the amount of postsurgery blood loss and thus the need for transfusion in the surgical treatment of femoral fractures [26]. However, since our primary objective was to investigate the AB0 blood system, we did not evaluate the effects of such protocols.…”

Section: Discussionmentioning

confidence: 98%

Relationship between the AB0 Blood System and Proximal Femoral Fracture Patterns in the Turkish Population

Kuru

Olçar

2020

BioMed Research International

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Objective. AB0 blood groups have shown to be associated with increased risk of several orthopedic disorders such as Achilles tendon rupture and hip osteoarthritis. The objective of this study was to investigate relationships between the AB0 blood system and hip fracture patterns, duration of hospitalization, and amount of blood transfusion. Methods. Data of 308 patients treated due to hip fractures in our hospital between 2017 and 2019 were evaluated. Epicrisis reports and X-rays of the patients included in this study were retrospectively screened, and hip fractures were classified as intracapsular and extracapsular fractures. Patients were divided into A, B, 0, and AB groups according to blood groups. Results. The mean age of the patients was 75.54±13.5 years. Of all patients, 103 had an intracapsular fracture and 205 had an extracapsular fracture. No statistically significant correlation was found between blood groups and fracture patterns. No statistically significant difference was found between the amounts of transfusion according to the blood groups, and no significant difference between the durations of hospitalizations according to the blood groups. Conclusion. In our study population, we could not find a significant relationship between the AB0 blood system and fracture patterns. We think that these potential relationships could be explained with further comprehensive studies with larger populations.

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Tranexamic Acid in Pertrochanteric Femoral Fracture: Is it a Safe Drug or Not?

Abstract: Based on this study, the use of tranexamic acid was statistically significant in reducing post-surgery blood loss.

Cited by 31 publications

References 34 publications

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

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

Efficacy and safety of tranexamic acid in elderly patients with intertrochanteric fracture: An updated meta-analysis

Relationship between the AB0 Blood System and Proximal Femoral Fracture Patterns in the Turkish Population

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