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Meta-Analysis
. 2022 Dec 1;36(12):e442-e448.
doi: 10.1097/BOT.0000000000002440.

The Use of Tranexamic Acid in Hip Fracture Surgery-A Systematic Review and Meta-analysis

Christabel Agius  1   2 , Elaine Cole  2 , Mary Grace Mifsud  1 , Aswinkumar Vasireddy  2   3
Affiliations
Meta-Analysis

The Use of Tranexamic Acid in Hip Fracture Surgery-A Systematic Review and Meta-analysis

Christabel Agius et al. J Orthop Trauma. .

Abstract

Objectives: To analyze the effect of intravenous tranexamic acid (TXA) on blood transfusion requirements in adult patients undergoing hip fracture surgery. Secondary aim was to evaluate the safety by assessing thromboembolic events.

Data sources: Cochrane Central Register of Controlled Trials, Medline, PubMed, and Embase were searched for randomized controlled trials published in English from 2010.

Study selection: Studies eligible for inclusion were randomized controlled trials that analyzed the use of intravenous TXA on blood transfusion requirement in hip fracture surgery.

Data extraction: Titles and abstracts were screened and assessed for eligibility by 2 independent reviewers. Quality and risk of bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach and the Cochrane risk-of-bias tool (RoB2).

Data synthesis: Meta-analysis with random and fixed effect models was performed. Risk ratio (RR) was calculated for dichotomous outcomes and estimated with a 95% confidence interval (CI). For continuous data, the risk difference (RD) was estimated with a 95% CI.

Results: A total of 13 trials involving 1194 patients were included. Pooled results showed that patients in the TXA group had significantly lower transfusion requirements (RR 0.50, 95%CI 0.30-0.84, P = 0.009). Similar findings were observed in the subcohort of patients with transfusion threshold of Hb < 8g/dL, (RR 0.42, 95%CI 0.31-0.56, P < 0.0001). This risk reduction was not observed in the subcohort of patients with transfusion threshold of Hb 8.1-10g/dL who received TXA (RR 0.77, 95%CI 0.51-1.18, P = 0.23) and no statistically significant differences were found for total thromboembolic events (RR 0.01, 95%CI -0.02-0.04, P = 0.47).

Conclusion: This meta-analysis demonstrated that intravenous TXA reduced blood transfusion rates and did not increase the risk of thromboembolic events.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Royal College of Physicians. National Hip Fracture Database [Internet]. 2019. Available at: https://www.nhfd.co.uk/ .
    1. Smeets SJM, Verbruggen JPAM, Poeze M. Effect of blood transfusion on survival after hip fracture surgery. Eur J Orthop Surg Traumatol. 2018;28:1297–1303.
    1. Puckeridge G, Terblanche M, Wallis M, et al. Blood management in hip fractures; are we leaving it too late? A retrospective observational study. BMC Geriatr. 2019;19:79.
    1. Emmerson BR, Varacallo M, Inman D. Hip fracture overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available at: http://www.ncbi.nlm.nih.gov/books/NBK557514/ .
    1. Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing. 2008;37:173–178.

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