Efficacy and safety of tranexamic acid in hip fracture surgery. How does dosage affect outcomes: A meta-analysis of randomized controlled trials |
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| Institution: | 1. Konstandopoulio General Hospital, 2nd Academic Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece;2. Evangelismos General Hospital, Orthopaedic Department, Athens, Greece;1. Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan;2. Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan;3. Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan;4. Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan;5. Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama, Japan;6. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan;1. The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia;2. The Australian National University, Canberra, Australian Capital Territory, Australia;3. The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia;1. Orthopedic Trauma Surgeon, Department of Orthopedic Trauma, Nottingham University Hospitals, Nottingham, UK;2. Chief of Orthopedic Trauma, Detroit Medical Center, Professor of Orthopedics, Wayne State University, 9B University Health Center, Detroit Receiving Hospital, 4201 St. Antoine Boulevard, Detroit, MI, 48201 United States;3. Professor of Orthopedics, 0490 McCaig Tower, Foothills Medical Center 3134 Hospital Dr NW Calgary, Alberta, T2N 5A1 Canada;1. Basaksehir Çam and Sakura City Training and Research Hospital, Department of Orthopaedics and Traumatology, ?stanbul, Turkey;2. University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Department of Orthopaedics and Traumatology, ?stanbul, Turkey |
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| Abstract: | AimThe objective of this study was to assess the efficacy and safety of intravenous TXA administration in elderly patients undergoing hip fracture surgery focusing on the effect of various dosages.MethodsA systematic search of PubMed, Embase and Cochrane Library was conducted until February 2021. Our primary outcome was peri?operative total blood loss, while secondary outcomes included transfusion rate, mean count of transfused RBC units and thromboembolic events’ incidence. A subgroup analysis was performed with respect to TXA dosage.ResultsOut of 146 records identified, 10 randomized controlled studies met the selection criteria. Data synthesis revealed that TXA resulted in a significant reduction in total blood loss by 229.45 ml in favor of TXA; 95% CI: 189.5, 269.4] and transfusion rate by 40%, RR = 0.60; 95% CI: 0.47, 0.78]. No increase in thromboembolic events rate was observed (RR = 1.08, 95% CI: 0.68, 1.69]) Furthermore, sub-analysis with respect to TXA dosage showed no significant difference in total blood loss reduction between “single” and “multiple doses” studies (223 vs 233.5 ml, p = 0.85.), while a trend for lower complications rate was observed in patients receiving a single dose of ≤ 15 mg/kg.ConclusionsThis meta-analysis provides strong evidence that TXA is a safe and effective agent to reduce perioperative blood loss in hip fracture surgery. When compared with higher dosages, a single dose of 15 mg/kg is associated with a non-significant reduction in adverse events, while achieving comparable outcomes. |
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