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

Qianzheng Zhu, Caixia Yu, Xingzuo Chen, Xiaodong Xu, Ying Chen, Chenggang Liu, Peng Lin, Qianzheng Zhu, Caixia Yu, Xingzuo Chen, Xiaodong Xu, Ying Chen, Chenggang Liu, Peng Lin

Abstract

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.

Keywords: intertrochanteric fracture; meta-analysis; randomized controlled trial; surgery; tranexamic acid.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of study selection.
Figure 2.
Figure 2.
Methodological quality of the randomized controlled trials (RCTs).
Figure 3.
Figure 3.
Forest plot for the transfusion rate.
Figure 4.
Figure 4.
Forest plot for the surgical blood loss.
Figure 5.
Figure 5.
Forest plot for the total blood loss.
Figure 6.
Figure 6.
Forest plot for the postoperative drainage.
Figure 7.
Figure 7.
Forest plot for the postoperative hematocrit.
Figure 8.
Figure 8.
Forest plot for the postoperative hemoglobin.
Figure 9.
Figure 9.
Forest plot for the thromboembolic events.
Figure 10.
Figure 10.
Forest plot for subgroup analysis of transfusion rate for different type of administration, dosage, and time.
Figure 11.
Figure 11.
Forest plot for subgroup analysis of transfusion rate for different transfusion trigger.

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Source: PubMed

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