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Meta-Analysis
. 2023 Jul 27;24(1):614.
doi: 10.1186/s12891-023-06725-y.

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Jiakai Zhang  1 , Xiaoyuan Fan  2 , Yi Zheng  1 , Junlong Wu  1 , Xinhua Yuan  3
Affiliations
Meta-Analysis

Intravenous application of tranexamic acid in intramedullary nailing for the treatment of geriatric intertrochanteric fractures: a systematic review and meta-analysis

Jiakai Zhang et al. BMC Musculoskelet Disord. .

Abstract

Background: Meta-analyses on the use of tranexamic acid (TXA) in intertrochanteric fractures have shown inconsistent results due to variations in inclusion criteria and clinical heterogeneity. To address these limitations, we conducted a rigorous analysis of recent randomized controlled trials (RCTs) with strict inclusion criteria. The aim of this study was to objectively evaluate the effects and safety of intravenous TXA administration in the treatment of geriatric intertrochanteric femoral fractures with intramedullary nailing.

Methods: PubMed, Embase, and the Cochrane Library were searched for 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 provides robust evidence supporting the efficacy and safety of intravenous TXA administration in treating geriatric intertrochanteric femoral fractures with intramedullary nailing. TXA significantly reduces blood loss and transfusion requirements without increasing the risk of thromboembolic events or mortality.

Keywords: Intertrochanteric fracture; Intramedullary nailing; Intravenous application; Tranexamic acid.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of study selection process
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Forest plot for total blood loss
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Fig. 4
Forest plot for intraoperative blood loss
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Fig. 5
Forest plot for hidden blood loss
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Fig. 6
Forest plot for transfusion rate of allogenic blood
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Fig. 7
Forest plot for transfused RBC units per patient
Fig. 8
Fig. 8
Forest plot for thromboembolic events rate
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Fig. 9
Forest plot for mortality
Fig. 10
Fig. 10
Funnel plot of thrombotic events
See this image and copyright information in PMC

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