Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1302
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
Processing time: 136 Days and 6 Hours
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.
This meta-analysis was designed to investigate the efficacy and safety of TXA in elderly ITF patients undergoing surgery.
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.
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).
In ITF surgery, intravenous administration of TXA reduces the risk of hidden blood loss and the need for allogeneic transfusion, without increasing thrombotic risk.
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.