The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

Yi-Ming Qi; Hai-Peng Wang; Ying-Juan Li; Bin-Bin Ma; Tian Xie; Chen Wang; Hui Chen; Yun-Feng Rui

doi:10.1016/j.jot.2019.03.007

The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: A systematic review and meta-analysis

J Orthop Translat. 2019 Apr 19:19:1-11. doi: 10.1016/j.jot.2019.03.007. eCollection 2019 Oct.

Authors

Yi-Ming Qi^{1

2

3

4}, Hai-Peng Wang⁵, Ying-Juan Li^{3

6}, Bin-Bin Ma^{1

2

3}, Tian Xie^{1

2

3

4}, Chen Wang^{1

2

3

4}, Hui Chen^{1

2

3

4}, Yun-Feng Rui^{1

2

3

4}

Affiliations

¹ Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
² Orthopaedic Trauma Institute of Southeast University, Nanjing, Jiangsu 210009, PR China.
³ Multidisciplinary Team (MDT) for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
⁴ School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.
⁵ The Department of Orthopedics, Jing' An District Centre Hospital of Shanghai (Huashan Hospital Fudan University Jing' An Branch), 20040, China.
⁶ Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China.

Abstract

Objective: The present meta-analysis was conducted to compare the efficacy and safety of intravenous application of tranexamic acid (TXA) with placebo in patients with hip fracture undergoing hip surgeries.

Methods: PubMed, EMBASE and Cochrane Library were searched from inception until March 2018. A combined searching strategy of subject words and random words was adopted. Only randomized clinical trials were included. The comparisons regarding transfusion rate, total blood loss, intraoperative blood loss, postoperative blood loss, postoperative haemoglobin and postoperative thromboembolic complications were conducted. The meta-analysis was performed using Review Manager 5.3, and the bias evaluation was based on the Cochrane Handbook 5.1.0.

Results: Ten randomized controlled trials published from 2007 to 2018 were included in the meta-analysis. The results showed that there were significant differences in the two groups concerning transfusion rate of allogeneic blood [risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.56 to 0.78, P = 0.003], total blood loss [mean difference (MD) = -273.00, 95% CI: -353.15 to -192.84, P < 0.00001], intraoperative blood loss (MD = -76.63, 95% CI: -139.55 to -13.71, P = 0.02), postoperative blood loss (MD = -125.29, 95% CI: -221.96 to -28.62, P = 0.01) and postoperative haemoglobin (MD = 0.80, 95% CI: 0.38 to 1.22, P = 0.0002). Nonsignificant differences were found in the incidence of thromboembolic events (RR = 1.38, 95% CI: 0.74 to 2.55, P = 0.31).

Conclusions: This meta-analysis of the available evidence implies that the intravenous route of TXA shows an ability to reduce transfusion requirements and total blood loss, not increasing the incidence of thromboembolic events in patients undergoing hip surgeries.

The translational potential of this article: The result of this meta-analysis shows that the utilization of intravenous TXA in patients with hip fracture undergoing hip surgeries possesses great potential in reducing blood loss and allogeneic blood transfusion safely.

Keywords: Allogeneic blood transfusion; Blood loss; Hip fracture; Meta-analysis; Randomized controlled trial, RCT; Thromboembolic events; Tranexamic acid; Tranexamic acid, TXA; cerebrovascular accident, CVA; confidence interval, CI; deep vein thrombolism, DVT; haemoglobin, Hb; mean difference, MD; pulmonary embolism, PE; risk ratio, RR; standard deviation, SD; total hip arthroplasty, THA; total knee arthroplasty, TKA.

Publication types

Review