Efficacy and safety of tranexamic acid in hip fracture surgery. How does dosage affect outcomes: A meta-analysis of randomized controlled trials. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Masouros, Panagiotis; Antoniou, Georgia; Nikolaou, Vasileios S.
• Is Part Of: Injury. Volume 53:Issue 2(2022)
• Page Start: 294
• Page End: 300
• Publication Date: 2022-02
• Subjects: Tranexamic acid -- Hip fracture -- Transfusion rates -- Total blood loss -- Meta-analysis; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.09.063
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Aim: The 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. Methods: A 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. Results: Out 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. Conclusions: This 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. Highlights: A single pre-operative dose of 15 mg/kg TXA can safely and effectively reduce perioperative blood loss and transfusion rates in hip fracture surgery. A second post-operative dose of TXA is not associated with any statistically significant benefit. No increase in thrombo-embolic events' rate was observed after TXA use in geriatric populations.