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

  • Cong Xiao
  • Shaoyun Zhang
  • Nengji Long
  • Wei Yu
  • Yishan JiangEmail author
Orthopaedic Surgery
  • 15 Downloads

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.

Keywords

Hip fracture Meta-analysis Thromboembolism Tranexamic acid Transfusion 

Notes

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.

Compliance with ethical standards

Conflict of interest

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

Ethical approval

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

Informed consent

Not applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cong Xiao
    • 1
  • Shaoyun Zhang
    • 1
  • Nengji Long
    • 1
  • Wei Yu
    • 1
  • Yishan Jiang
    • 1
    Email author
  1. 1.Department of OrthopedicsThe Third Hospital of Mianyang (Sichuan Mental Health Center)MianyangChina

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