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Is intravenous tranexamic acid effective and safe during hip fracture surgery? An updated meta-analysis of randomized controlled trials

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The efficacy and safety of intravenous (IV) tranexamic acid (TXA) during hip fracture surgery remain controversial. This meta-analysis aimed to assess the efficacy of IV-TXA administration during hip fracture surgery for reducing the transfusion requirement and blood loss as well as its safety regarding the risk of thrombolysis.

Materials and methods

PubMed, EMBASE, Web of Science, and the Cochrane Library Database were systematically searched for randomized controlled trials (RCTs) that focused on the efficacy and safety of IV-TXA in patients during hip fracture surgery. The primary outcome was the transfusion requirement. Secondary outcomes included total blood loss (TBL), deep vein thrombosis (DVT), and total thromboembolic events (TTEs). Risk ratio (RR), risk difference (RD), and mean difference (MD) for dichotomous and continuous data outcomes were determined from the meta-analysis. Data were analyzed using Rev Man 5.3.

Results

Altogether, 11 RCTs were included (total sample size 892 patients). IV-TXA significantly reduced the transfusion requirement [RR 0.60, 95% confidence interval (CI) 0.38–0.93, P = 0.02] and TBL (MD 326.64 ml, 95% CI − 462.23 to − 191.06, P < 0.00001) vs. cosntrol group. IV-TXA caused no increased risk of DVT (RD 0.02, 95% CI − 0.01 to 0.04, P = 0.13) or TTEs (RD 0.02, 95% CI − 0.01 to 0.05, P = 0.12).

Conclusion

Available evidence indicates that IV-TXA efficaciously reduces TBL and transfusion requirements during hip fracture surgery without significantly increasing the risk of TTEs including DVT.

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Acknowledgements

We thank Jinwei Xie from West China Hospital, Sichuan University for providing language help and writing assistance.

Funding

This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.

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Author notes

  1. Cong Xiao and Shaoyun Zhang contributed equally to this work and should be considered as equal first authors.

Authors and Affiliations

  1. Department of Orthopedics, The Third Hospital of Mianyang (Sichuan Mental Health Center), No. 190 The East Jiannan Road, Mianyang, 621000, China

    Cong Xiao, Shaoyun Zhang, Nengji Long, Wei Yu & Yishan Jiang

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  1. Cong Xiao
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  2. Shaoyun Zhang
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  3. Nengji Long
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Correspondence to Yishan Jiang.

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None of the authors has financial or personal relationships with other people or organizations that could inappropriately influence this work.

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Because this study was a literature review, ethical approval was not obtained.

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Xiao, C., Zhang, S., Long, N. et al. Is intravenous tranexamic acid effective and safe during hip fracture surgery? An updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 139, 893–902 (2019). https://doi.org/10.1007/s00402-019-03118-6

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  • DOI: https://doi.org/10.1007/s00402-019-03118-6

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