Efficacy and safety of tranexamic acid in orthopaedic trauma surgery: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAO Ruzhan ¹ , WANG Bingwu ² , PAN Hongfa ² ,  WANG Guanglin ¹

1. Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Spinal Surgery, Weifang People’s Hospital, Weifang, 261000, P.R.China;

Corresponding author：

WANG Guanglin, Email: wglfrank@163.com

Keywords：

Tranexamic acid; Traumatic fracture; Blood loss; Blood transfusion; Meta-analysis; RCT

DOI：

10.7507/1672-2531.201808138

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.Methods A systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.Results A total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.Conclusions TXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.

Citation： YAO Ruzhan, WANG Bingwu, PAN Hongfa, WANG Guanglin. Efficacy and safety of tranexamic acid in orthopaedic trauma surgery: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(3): 331-337. doi: 10.7507/1672-2531.201808138 Copy

1.	Piggott RP, Leonard M. Is there a role for antifibrinolytics in pelvic and acetabular fracture surgery. Ir J Med Sci, 2015, 185(1): 29-34.
2.	Tengberg PT, Foss NB, Palm H, et al. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial. Bone Joint J, 2016, 98-B(6): 747.
3.	Saleh A, Small T, Chandran PAL, et al. Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009. J Bone Joint Surg Am, 2014, 96(18): e155.
4.	Zhu C, Gao Y, Li Z, et al. A systematic review and meta-analysis of the clinical appropriateness of blood transfusion in China. Medicine, 2015, 94(50): e2164.
5.	Wang W, Yu J. Tranexamic acid reduces blood loss in intertrochanteric fractures: a meta-analysis from randomized controlled trials. Medicine, 2017, 96(52): e9396.
6.	Jennings JD, Solarz MK, Christopher H. Application of tranexamic acid in trauma and orthopedic surgery. Orthop Clin North Am, 2016, 47(1): 137-143.
7.	Yi Z, Bin S, Jing Y, et al. Tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration. J Bone Joint Surg Am, 2016, 98(12): 983-991.
8.	Shin YS, Yoon JR, Lee HN, et al. Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2016, 25(11): 1-11.
9.	Hui S, Xu D, Ren Z, et al. Can tranexamic acid conserve blood and save operative time in spinal surgeries? a meta-analysis. Spine J, 2017, 12(11): 17-24.
10.	Abu D, Balakrishnan R, Vijay E, et al. Efficacy of tranexamic acid in reducing blood loss during maxillofacial trauma surgery-a pilot study. J Clin Diagn Res, 2014, 8(5): ZC06-8.
11.	Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet, 2017, 389(10084): 2105-2116.
12.	Xie B, Tian J, Zhou DP. Administration of tranexamic acid reduces postoperative blood loss in calcaneal fractures: a randomized controlled trial. J Foot Ankle Surg, 2015, 54(6): 1106-1110.
13.	Haghighi M, Ettehad H, Mardanikivi M, et al. Does tranexamic acid reduce bleeding during femoral fracture operation. Arch Bone Jt Surg, 2017, 5(2): 103-108.
14.	Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hongkong), 2016, 24(3): 379-382.
15.	Watts CD, Houdek MT, Sems SA, et al. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: a randomized clinical trial. J Orthop Trauma, 2017, 31(7): 345-351.
16.	Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
17.	Drakos A, Raoulis V, Karatzios K, et al. Efficacy of local administration of tranexamic acid for blood salvage in patients undergoing intertrochanteric fracture surgery. J Orthop Trauma, 2016, 30(8): 409-414.
18.	Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
19.	Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124-129.
20.	王小军, 陈永华, 程昊, 等. TXA 应用于股骨转子间骨折的有效性和安全性分析. 浙江医学, 2017, 39(16): 1373-1375.
21.	Zhu J, Zhu Y, Lei P, et al. Efficacy and safety of tranexamic acid in total hip replacement: a PRISMA-compliant meta-analysis of 25 randomized controlled trials. Medicine, 2017, 96(52): e9552.
22.	Guo P, He Z, Wang Y, et al. Efficacy and safety of oral tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis. Medicine, 2018, 97(18): e0587.
23.	Pei Z, He J, Fang Y, et al. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine, 2017, 96(21): e6940.
24.	Geerts W. Prevention of venous thromboembolism: American college of chest physiciants evidence-based clinical practice guidelines. Chest, 2008, 133(6): 381S-453S.
25.	Lang E. Early treatment with tranexamic acid reduced bleeding death in patients with clinically important hemorrhage due to trauma. Ann Intern Med, 2011, 155(2): JC1-4.

1. Piggott RP, Leonard M. Is there a role for antifibrinolytics in pelvic and acetabular fracture surgery. Ir J Med Sci, 2015, 185(1): 29-34.
2. Tengberg PT, Foss NB, Palm H, et al. Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip: results of a randomised controlled trial. Bone Joint J, 2016, 98-B(6): 747.
3. Saleh A, Small T, Chandran PAL, et al. Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009. J Bone Joint Surg Am, 2014, 96(18): e155.
4. Zhu C, Gao Y, Li Z, et al. A systematic review and meta-analysis of the clinical appropriateness of blood transfusion in China. Medicine, 2015, 94(50): e2164.
5. Wang W, Yu J. Tranexamic acid reduces blood loss in intertrochanteric fractures: a meta-analysis from randomized controlled trials. Medicine, 2017, 96(52): e9396.
6. Jennings JD, Solarz MK, Christopher H. Application of tranexamic acid in trauma and orthopedic surgery. Orthop Clin North Am, 2016, 47(1): 137-143.
7. Yi Z, Bin S, Jing Y, et al. Tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration. J Bone Joint Surg Am, 2016, 98(12): 983-991.
8. Shin YS, Yoon JR, Lee HN, et al. Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2016, 25(11): 1-11.
9. Hui S, Xu D, Ren Z, et al. Can tranexamic acid conserve blood and save operative time in spinal surgeries? a meta-analysis. Spine J, 2017, 12(11): 17-24.
10. Abu D, Balakrishnan R, Vijay E, et al. Efficacy of tranexamic acid in reducing blood loss during maxillofacial trauma surgery-a pilot study. J Clin Diagn Res, 2014, 8(5): ZC06-8.
11. Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet, 2017, 389(10084): 2105-2116.
12. Xie B, Tian J, Zhou DP. Administration of tranexamic acid reduces postoperative blood loss in calcaneal fractures: a randomized controlled trial. J Foot Ankle Surg, 2015, 54(6): 1106-1110.
13. Haghighi M, Ettehad H, Mardanikivi M, et al. Does tranexamic acid reduce bleeding during femoral fracture operation. Arch Bone Jt Surg, 2017, 5(2): 103-108.
14. Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hongkong), 2016, 24(3): 379-382.
15. Watts CD, Houdek MT, Sems SA, et al. Tranexamic acid safely reduced blood loss in hemi- and total hip arthroplasty for acute femoral neck fracture: a randomized clinical trial. J Orthop Trauma, 2017, 31(7): 345-351.
16. Lack WD, Crist BD, Seymour RB, et al. Effect of tranexamic acid on transfusion: a randomized clinical trial in acetabular fracture surgery. J Orthop Trauma, 2017, 31(10): 526-530.
17. Drakos A, Raoulis V, Karatzios K, et al. Efficacy of local administration of tranexamic acid for blood salvage in patients undergoing intertrochanteric fracture surgery. J Orthop Trauma, 2016, 30(8): 409-414.
18. Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth, 2010, 104(1): 23-30.
19. Lei J, Zhang B, Cong Y, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res, 2017, 12(1): 124-129.
20. 王小军, 陈永华, 程昊, 等. TXA 应用于股骨转子间骨折的有效性和安全性分析. 浙江医学, 2017, 39(16): 1373-1375.
21. Zhu J, Zhu Y, Lei P, et al. Efficacy and safety of tranexamic acid in total hip replacement: a PRISMA-compliant meta-analysis of 25 randomized controlled trials. Medicine, 2017, 96(52): e9552.
22. Guo P, He Z, Wang Y, et al. Efficacy and safety of oral tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis. Medicine, 2018, 97(18): e0587.
23. Pei Z, He J, Fang Y, et al. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis. Medicine, 2017, 96(21): e6940.
24. Geerts W. Prevention of venous thromboembolism: American college of chest physiciants evidence-based clinical practice guidelines. Chest, 2008, 133(6): 381S-453S.
25. Lang E. Early treatment with tranexamic acid reduced bleeding death in patients with clinically important hemorrhage due to trauma. Ann Intern Med, 2011, 155(2): JC1-4.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of tranexamic acid in orthopaedic trauma surgery: a meta-analysis

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