Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2019; 7(11): 1302-1314
Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1302
Efficacy and safety of tranexamic acid in elderly patients with intertrochanteric fracture: An updated meta-analysis
Xin-Die Zhou, Jin Li, Guo-Ming Fan, Yong Huang, Nan-Wei Xu
Xin-Die Zhou, Yong Huang, Nan-Wei Xu, Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China
Jin Li, Guo-Ming Fan, Department of Orthopedic Surgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
Author contributions: Zhou XD and Li J contributed equally to this work; Zhou XD, Huang Y, and Xu NW designed the research; Zhou XD, Li J, and Fan GM performed the research; Zhou XD and Li J contributed new reagents/analytic tools; Zhou XD, Li J, and Xu NW analyzed the data; and Zhou XD, Li J, and Huang Y wrote the paper.
Supported by (in part) National Natural Science Foundation of China, No. 81702179; and Major Scientific and Technological Project of Changzhou Municipal Commission of Health and Family Planning, No. ZD201809.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Huang, MD, Doctor, Full Professor, Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou 213003, Jiangsu Province, China. huangyong@njmu.edu.cn
Telephone: +86-519-88123506 Fax: +86-519-88123506
Received: January 22, 2019
Peer-review started: January 23, 2019
First decision: January 27, 2019
Revised: February 15, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: June 6, 2019
Abstract
BACKGROUND

Intertrochanteric fracture (ITF) is a common type of injury, and nearly 30% of ITF patients die in the first 12 mo, especially the elderly with limited activity. Tranexamic acid (TXA) has been widely used in reducing traumatic and surgical bleeding, however, the paucity of studies regarding its use in orthopedic trauma surgery has limited its integration into this field, which may benefit most from TXA. The safety of TXA in this group has not achieved a consensus.

AIM

This meta-analysis was designed to investigate the efficacy and safety of TXA in elderly ITF patients undergoing surgery.

METHODS

Databases, including Medline and PubMed, were searched for randomized controlled trials (RCTs) that were published before October 2018 and that addressed the efficacy and safety of TXA in patients who underwent ITF surgery. The Consolidated Standards of Reporting Trials 2010 Statement Checklist was used to assess the methodological quality of each study. Trials without and with heterogeneity were compared by fixed-effects analysis and random-effects analysis, respectively. For each study, odds ratio (OR) and 95%CI and mean differences and 95%CI were calculated for dichotomous and continuous outcomes, respectively. The Power and Sample Size Program software was used to calculate power and sample size. Stability of the results was assessed via sensitivity analysis.

RESULTS

A total of 836 patients from eight RCTs were subjected to meta-analysis. TXA treatment compared with the control group significantly reduced postoperative blood loss (95%CI, -20.83 to -7.93 mL, P < 0.0001), hidden blood loss (95%CI, -213.67 to -64.43 mL, P = 0.0003), and total blood loss (95%CI, -332.49 to -23.18 mL, P = 0.02) by weighted mean differences of -14.38, -139.05, and -177.83 mL, respectively. However, no significant difference was observed between groups for analysis of intraoperative blood loss. The meta-analysis also proved that the usage of TXA in ITFs may not significantly increase the incidence of deep venous thrombosis. Allogeneic blood transfusion data showed that significantly fewer patients in the TXA group (42%) required transfusion than the control group (95%CI, 0.36 to 0.69; P < 0.0001).

CONCLUSION

In ITF surgery, intravenous administration of TXA reduces the risk of hidden blood loss and the need for allogeneic transfusion, without increasing thrombotic risk.

Keywords: Tranexamic acid, Intertrochanteric fracture, Blood loss, Randomized controlled trial, Meta-analysis

Core tip: Intertrochanteric fracture (ITF) is a common type of injury in the elderly population. Although minimally invasive surgical therapy has been routinely performed, the overall blood loss volume may still be much larger than that observed. Tranexamic acid (TXA) has been widely used in reducing surgical bleeding, however, the paucity of studies regarding its use in ITF surgery has limited its integration into this field. Thus, in order to investigate the efficacy and safety of TXA administration in elderly ITF patients, we meta-analyzed the relevant literature regarding the potential risks and benefits of TXA in ITF surgery.