Shahid Miangul1,2, Timothy Oluwaremi3,4, Joe El Haddad3,4, Maamoun Adra3,4, Nathan Pinnawala3,4, Hayato Nakanishi3,4, Reem H Matar3,4,5, Christian A Than3,4,6, Thomas M Stewart7. 1. St George's University of London, London, SW17 0RE, UK. shahster96@gmail.com. 2. University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus. shahster96@gmail.com. 3. St George's University of London, London, SW17 0RE, UK. 4. University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus. 5. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. 6. School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia. 7. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Abstract
AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS: Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD = - 196.91 mL, 95% CI - 247.59, - 146.23, I2 = 92%), intraoperative blood loss (MD = - 26.86 mL, 95% CI - 36.96, - 16.78, I2 = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I2 = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I2 = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I2 = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I2 = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I2 = 0%). CONCLUSION: Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients.
AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS: Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD = - 196.91 mL, 95% CI - 247.59, - 146.23, I2 = 92%), intraoperative blood loss (MD = - 26.86 mL, 95% CI - 36.96, - 16.78, I2 = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I2 = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I2 = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I2 = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I2 = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I2 = 0%). CONCLUSION: Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients.
Authors: Matthew P Abdel; Brian P Chalmers; Michael J Taunton; Mark W Pagnano; Robert T Trousdale; Rafael J Sierra; Yuo-Yu Lee; Friedrich Boettner; Edwin P Su; Steven B Haas; Mark P Figgie; David J Mayman Journal: J Bone Joint Surg Am Date: 2018-06-20 Impact factor: 5.284
Authors: C Cooper; Z A Cole; C R Holroyd; S C Earl; N C Harvey; E M Dennison; L J Melton; S R Cummings; J A Kanis Journal: Osteoporos Int Date: 2011-04-02 Impact factor: 4.507