Tranexamic Acid Safely Reduced Blood Loss in Hemi- and Total Hip Arthroplasty for Acute Femoral Neck Fracture: A Randomized Clinical Trial

Watts, Chad D.; Houdek, Matthew T.; Sems, Stephen A.; Cross, William W.; Pagnano, Mark W.

doi:10.1097/bot.0000000000000837

Cited by 71 publications

(85 citation statements)

References 33 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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“…After full texts carefully read for eligibility, two studies were excluded, because they were just an abstract. 16 , 17 Finally, 12 RCTs 18 – 21 , 23 – 30 and 1 retrospective cohort study 22 were included. The characteristics of all included studies are shown in Tables 1 and 2 .…”

Section: Resultsmentioning

confidence: 99%

“…The value of weighted kappa for the agreement on these studies between reviewers was excellent ( κ = 0.72). Ten studies 18 – 21 , 23 , 25 , 26 , 28 – 30 were of high quality, and two studies were of moderate quality. 24 , 27 The randomization methods were explicitly introduced in nine studies.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of tranexamic acid usage in patients undergoing femoral fracture surgery

Zhang¹,

Bai²,

He³

et al. 2018

CIA

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BackgroundPatients undergoing femoral fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease transfusion rate in joint replacement surgery. Therefore, we conducted a systematic review to evaluate the efficacy and safety of TXA usage in femoral fracture surgery.Materials and methodsStudies involving TXA usage in femoral fracture surgery were searched through four electronic databases. The end points included total blood loss, postoperative hemoglobin decline, transfusion rate, thromboembolic events, 90-day mortality, and operative time. The present study was performed following Cochrane Reviewers’ Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was carried out by using Stata 14.0 software.ResultsEleven studies concerning intravenous (IV) application of TXA and three studies concerning topical administration of TXA were included. Twelve studies were randomized controlled trials (RCTs), and one was a retrospective cohort study. Regarding IV TXA, our paper indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = −319.282, P = 0.000), lower postoperative hemoglobin decline (WMD = −1.14, P = 0.000) and lower transfusion rate (risk difference [RD] = −0.172, P = 0.000). No significant differences were found in thromboembolic events (RD = 0.008, P = 0.507), 90-day mortality (RD = 0.009, P = 0.732) and operative time (WMD = −2.227, P = 0.103). Regarding topical TXA, no significant differences were found in the transfusion rate (RD = −0.098, P = 0.129), postoperative hemoglobin decline (WMD = −1.137, P = 0.231), thromboembolic events (RD = −0.017, P = 0.660) and operative time (WMD = −4.842, P = 0.136).ConclusionOur meta-analysis demonstrated that both IV and topical application of TXA reduced transfusion rate in femoral fracture surgery. However, still further studies are needed to identify the optimal route of administration, TXA dosage and timing. In addition, high-quality RCTs with a large sample size are required to figure out the safety of TXA application, especially in the elderly, before its wide recommendation.

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“…In recent 10 years, surgical techniques and perioperative management guidelines have made gratifying progress in THA, promoting the rapid recovery of patients. Tranexamic acid (TXA), a synthetic analog of lysine, inhibits fibrinolysis by competitively blocking the lysine binding site of plasminogen, often used for joint replacement to reduce perioperative blood loss, and it has anti‐inflammatory effects. Dexamethasone (DEX), with a strong anti‐inflammatory agent, has been widely used to reduce inflammatory markers, prevent PONV, and relieve postoperative pain and fatigue in various perioperative periods.…”

Section: Introductionmentioning

confidence: 99%

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the efficacy and safety of combined use of tranexamic acid (TXA) and dexamethasone (DEX) for anti-inflammatory and clinical outcomes after total hip arthroplasty (THA). Methods:A total of 100 patients were included in this randomized, controlled study. Patients in the TXA + DEX group were administered TXA at a dose of 15 mg/kg, which was repeated 3 h after THA, and received 20 mg DEX. In contrast, patients in the TXA group were administered TXA at a dose of 15 mg/kg, which was repeated at 3 h postoperatively. C-reactive protein (CRP), interleukin-6 (IL-6) and pain levels, incidence of postoperative nausea and vomiting (PONV), total blood loss and transfusion rates, postoperative fatigue, range of motion (ROM), length of hospital stay (LOS), analgesic rescue and antiemetic rescue consumption, and complications were compared in both groups. Results:The CRP and IL-6 levels were lower in the TXA + DEX group than in the TXA group (all P < 0.001) at 24 h, 48 h, and 72 h postoperatively. Patients in the TXA + DEX group had lower pain scores at rest and walking at 24 h postoperatively (all P < 0.001). In the TXA + DEX group, the incidence of PONV was lower (P = 0.005), postoperative fatigue (P < 0.001) was reduced, and analgesia and antiemetic rescue consumption were also reduced. The total blood loss, transfusion rate, LOS and hip ROM were similar in the two groups. There was no thrombosis, infection, or gastrointestinal bleeding in either group.Conclusion: Compared to TXA alone, the combination of TXA + DEX can reduce postoperative inflammatory response, relieve pain, and reduce PONV and fatigue, without increasing the risk of complications. Therefore, the present study suggested that the combination of TXA + DEX is an effective and safe accelerated rehabilitation strategy for patients receiving primary unilateral THA.

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Tranexamic Acid Safely Reduced Blood Loss in Hemi- and Total Hip Arthroplasty for Acute Femoral Neck Fracture: A Randomized Clinical Trial

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 71 publications

References 33 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

A systematic review of tranexamic acid usage in patients undergoing femoral fracture surgery

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

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