The effect of tranexamic acid in open reduction and internal fixation of pelvic and acetabular fracture: A systematic review and meta-analysis

Abstract

Background: Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture.

Methods: MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications.

Results: We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference -64.67, 95% confidence interval [CI] -185.27 to -55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19-3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44-5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13-9.98, P = .90, I2 = 48%).

Conclusions: Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.

Figure 1.

PRISMA flow diagram for the identification and selection of studies included in the meta-analysis. PRISMA = Preferred Reporting Items for Systematic reviews and Meta-analyses.

Figure 2.

Forest plot showing the EBL between the TXA and control groups. CI = confidence interval, EBL = estimated blood loss, SD = standard deviation, TXA = tranexamic acid.

Figure 3.

Forest plot showing the transfusion rate between the TXA and control groups in overall study period (A) and postoperative period (B). CI = confidence interval, TXA = tranexamic acid.

Figure 4.

Forest plot showing the incidence of postoperative VTE (A) and infection (B) between the TXA and control groups. CI = confidence interval, TXA = tranexamic acid, VTE = venous thromboembolism.