To assess the outcomes associated with the use of tranexamic acid in the open fixation of pelvic and acetabular fractures- A systematic review

Abstract

AbstractBackground There is a growing knowledge base for the use of antifibrinolytic therapy in trauma and orthopaedic surgery. The mechanism of action of tranexamic acid is through the inhibition of fibrinolysis. The role of TXA in hip fractures has been researched extensively. However, the research has been limited in the realms of pelvic and acetabular fractures. Aim This systematic review aimed to examine the effect of TXA on patients undergoing open pelvic and acetabular fracture surgery. The primary aim of the study was to examine the estimated blood loss and blood transfusion rates in patients who received TXA versus those who did not receive TXA. The secondary aim was to examine the rates of deep venous thrombosis. Method A literature search was carried out using PubMed, Medline and the Cochrane database. The selection criteria for the systematic review were studies investigating intravenous TXA in the form of RCTs, as well as cohort studies. Results Five studies were included in the systematic review with 625 total patients. The estimated blood loss between the two groups was noted to be 661 ml in the control group and 850 ml in the TXA (p = 0.49). There was a marginally lower number of units transfused in the control group vs the TXA group (1.9 vs 2.2) (p = 0.27). The rates of transfusion in the TXA group were 29% TXA whilst in the control group, it was 31%(p = 0.13). The overall incidence of deep venous thrombosis was 2.8% in the TXA group and 1.7% in the control group(p = 0.097). Conclusion The results of this systematic review highlight that with the use of TXA the estimated blood loss and rates of DVT are not statistically significantly lower when compared to the groups that did not receive TXA. There is a greater need for larger adequately powered trials to further evaluate the results of this review.