Tranexamic acid reduces blood loss in intertrochanteric fractures

Wang, Weidong; Yu, Jincong

doi:10.1097/md.0000000000009396

Cited by 14 publications

(14 citation statements)

References 24 publications

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“…22,23 Previous meta-analyses have shown nearly uniform ability of TXA to limit the proportion of transfused patients after hip fractures. 24 –26 Contrarily, in this study, we found no significant difference in the transfusion rate among different groups. Nevertheless, there was a notable heterogeneity in the analysis of transfusion rate, and sensitivity analysis showed insufficient evidence to verify difference.…”

Section: Discussioncontrasting

confidence: 48%

“…The meta-analysis by Wang and Yu 26 addressing similar questions has been recently published that considers RCT until September 2017. Yet, it had 3 main differences from ours.…”

Section: Discussionmentioning

confidence: 99%

“…First, Wang and Yu 26 concluded that “local administration of tranexamic acid is associated with a reduced transfusion requirements in patients with intertrochanteric fractures.” However, our meta-analysis showed no significant between-group difference in the transfusion rate. Second, Wang and Yu 26 concluded that “the evidence quality for each outcome is high.” In our meta-analysis, risk of bias and inconsistency were found to downgrade the quality of evidence. Further research is likely to have an important impact on our confidence in the estimate of effect.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Zhu

Chen

et al. 2018

Clin Appl Thromb Hemost

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The use of tranexamic acid (TXA) for reducing blood loss in intertrochanteric fracture (IF) surgery remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TXA in reducing transfusion requirements and blood loss for IF surgery. Databases, including PubMED, Cochrane, and Embase, were searched for RCTs that were published before February 2018 and that addressed the efficacy and safety of TXA in patients who underwent IF surgery. A total of 746 patients from 7 RCTs were subjected to meta-analysis. The results showed that TXA group had reduced surgical blood loss (weighted mean difference [WMD] = -37.24, 95% confidence interval [CI]: -48.70 to -25.77, P <.00001), reduced total blood loss (WMD = -199.08, 95% CI: -305.16 to -93.01, P = .0002), higher postoperative hemoglobin (WMD = 0.46, 95% CI: 0.12 to 0.79, P = .007), and hematocrit levels (WMD = 1.55, 95% CI: 0.64 to 2.47, P = .008) compared to control group, while no significant differences were found in transfusion rates (relative risk [RR] = 0.75, 95% CI: 0.50 to 1.11, P = .15), postoperative drainage (WMD = -38.82, 95% CI: -86.87 to 9.22, P = .11), and thromboembolic events (RR = 0.94, 95% CI: 0.41 to 2.19, P = .89). In patients undergoing IF surgery, the administration of TXA significantly reduced surgical blood loss and total blood loss, while it had no significant effect on transfusion rate, postoperative drainage, and the risk of thromboembolic events. Nevertheless, due to the variations in the included studies, additional RCTs are required to further validate these conclusions.

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Section: Discussioncontrasting

confidence: 48%

“…The meta-analysis by Wang and Yu 26 addressing similar questions has been recently published that considers RCT until September 2017. Yet, it had 3 main differences from ours.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Zhu

Chen

et al. 2018

Clin Appl Thromb Hemost

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“…The fibrinolysis system is activated after the initial trauma and continuous HBL is occurring before surgery. 10 24 This is in accord with our previous published work and may suggest an ongoing hyperfibrinolysis from admission to POD3. 25 However, to date, studies have only reported the haemostatic efficacy of TXA on the blood loss related to surgery, while there is a lack of evidence about the blood-sparing efficacy of TXA on the preoperative HBL caused by the initial fracture.…”

Section: Discussionsupporting

confidence: 92%

Study protocol: haemostatic efficacy and safety of preemptive antifibrinolysis with multidose intravenous tranexamic acid in elderly hip fracture patients: design of a prospective randomised controlled trial

et al. 2021

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IntroductionHip fracture surgery is often associated with substantial blood loss and a high allogeneic blood transfusion (ABT) rate. Preoperative hidden blood loss (HBL) has been observed clinically but there is little evidence for the efficacy of tranexamic acid (TXA) in controlling preoperative HBL. We designed a randomised controlled trial to evaluate the efficacy of preemptive antifibrinolysis with multidose intravenous TXA (IV-TXA) in reducing preoperative HBL in elderly patients with hip fractures.Methods and analysisThis is a prospective, randomised, placebo-controlled clinical trial. Patients older than 65 years diagnosed with primary unilateral femoral neck fracture or intertrochanteric fracture will be randomly assigned to group A (receiving 100 mL of intravenous normal saline every 12 hours preoperatively and 1.5 g of IV-TXA every 12 hours postoperatively for 3 days) or group B (receiving 1.5 g of IV-TXA every 12 hours preoperatively and 1.5 g of IV-TXA every 12 hours postoperatively for 3 days). The primary outcomes will be the hidden blood loss, haemoglobin decrease and ABT rate. The secondary outcomes include the levels of inflammatory factors (such as C reactive protein) and coagulation and fibrinolysis parameters (such as D-dimer). Other outcomes such as injury time, length of stay and hospitalisation expenses will also be compared between groups.Ethics and disseminationThis study has been approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. The findings of the study will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberChiCTR2100045960.

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“…The conclusions also were notarized by our meta-analysis. Our meta-analysis involving 836 participants from eight RCTs is an update of another meta-analysis[48] involving only four studies and 514 participants, but the findings are similar.…”

Section: Discussionsupporting

confidence: 56%

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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Tranexamic acid reduces blood loss in intertrochanteric fractures

Abstract: Local administration of tranexamic acid is associated with a reduced total blood loss, postoperative hemoglobin decline, and transfusion requirements in patients with intertrochanteric fractures. High-quality RCTs are still required for further investigation.

Cited by 14 publications

References 24 publications

Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Efficacy and Safety of Tranexamic Acid for Blood Salvage in Intertrochanteric Fracture Surgery: A Meta-Analysis

Study protocol: haemostatic efficacy and safety of preemptive antifibrinolysis with multidose intravenous tranexamic acid in elderly hip fracture patients: design of a prospective randomised controlled trial

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

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