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
Processing time: 136 Days and 6 Hours
ARTICLE HIGHLIGHTS
Research background

Intertrochanteric fracture is a common type of injury, and nearly 30% of intertrochanteric fracture patients die in the first 12 mo, especially the elderly with limited activity. With the improvement of surgical methods, minimal invasive surgical therapy has significantly reduced trauma with reliable efficacy. Anyway, the overall blood loss volume may be much larger than that observed. Tranexamic acid has been widely used in reducing traumatic and surgical bleeding, however, the paucity of studies regarding its use in orthopedic trauma has limited its integration into this field, which may benefit most from tranexamic acid. The safety of tranexamic acid in this group has not achieved a consensus.

Research motivation

Recently, the impact of tranexamic acid on intertrochanteric fracture surgery has been controversial due to several studies. For instance, some studies reported that the association between tranexamic acid and intertrochanteric fracture was significant, while others reported the opposite conclusion.

Research objectives

To date, although several studies focus on the use of tranexamic acid in hip fractures, the results have been controversial and limited. Thus, in order to investigate and help determine the efficacy and safety of tranexamic acid administration in reducing bleeding and transfusion in elderly intertrochanteric fracture patients, we meta-analyzed the relevant literature regarding the potential risks and benefits of tranexamic acid in intertrochanteric fracture surgery.

Research methods

We searched Medline and PubMed for the publications in English (up to October 2018), that focused on the effectiveness and safety of tranexamic acid on the intertrochanteric fracture. 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.

Research results

After a detailed evaluation, eight independent randomized controlled trials with cumulatively 836 patients were included in the overall meta-analysis. Tranexamic acid 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. But no significant difference was observed between groups for analysis of intraoperative blood loss. The meta-analysis also proved that the usage of tranexamic acid in intertrochanteric fractures may not significantly increase the incidence of deep vein thrombosis. Allogeneic blood transfusion data showed that significantly fewer patients in the tranexamic acid group (42%) required transfusion than the control group (95%CI, 0.36 to 0.69; P < 0.0001).

Research conclusions

Our study suggests the use of tranexamic acid in intertrochanteric fracture surgery significantly reduced the risk of hidden blood losses as well as the need for allogeneic transfusion, without increasing other complications, especially deep vein thrombosis, particularly for intravenous use. However, larger high-quality prospective trials are required to strengthen our conclusions, define the optimal regimen, and assess the safety and cost-effectiveness of tranexamic acid before its use is recommended in intertrochanteric fracture surgery.