Affiliation:
1. Ningbo No. 2 Hospital
2. The Affiliated People's Hospital of Ningbo University
Abstract
Abstract
Background: Recently, several meta-analyses on the use of tranexamic acid in intertrochanteric fractures have been published. However, their inclusion criteria were not rigorous enough, and the clinical heterogeneity was high, leading to less reliable results. Therefore, we used more stringent criteria to include the most recent randomized controlled studies. The aim was to evaluate the effects and safety of intravenous application of tranexamic acid in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing.
Methods: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) published from the database inception to August 2022. The date of total blood loss (TBL), intra-operative blood loss (IBL), hidden blood loss (HBL), transfusion rate, transfusion units, thromboembolic events, and mortality were extracted. Review Manager 5.3 was used for the analysis.
Results: A total of six RCTs involving 689 patients were included. Meta-analyses indicated that TXA can significantly reduce TBL (WMD = -232.82; 95% CI -312.81 to -152.84; p < 0.00001), IBL (WMD = -36.33; 95% CI -51.38 to -21.28; p < 0.00001), HBL (WMD = -189.23; 95% CI -274.92 to -103.54; p < 0.0001), transfusion rate (RR = 0.53; 95% CI 0.33 to 0.85; p = 0.008), and transfusion units (WMD = -0.58; 95% CI -0.75 to -0.41; p < 0.01). No increase in thromboembolic events rate (RR = 0.75; 95% CI 0.38 to 1.50; p = 0.42) and mortality (RR = 1.36; 95% CI 0.61 to 3.04; p = 0.45) was observed.
Conclusions: Our meta-analysis suggested that intravenous administration of TXA in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing is effective and safe. TXA resulted in a significant reduction in TBL, IBL, HBL, transfusion rate and units, without increasing the risk of thromboembolic events and mortality.
Publisher
Research Square Platform LLC