Abstract
Background
Elderly patients with femoral neck fracture have high perioperative blood loss according
to the trauma and hip arthroplasty surgery. Tranexamic acid is a fibrinolytic inhibitor
and has been widely used in hip fracture patients to against perioperative anemia.
The aim of the present meta-analysis was to evaluate the efficacy and safety of Tranexamic
acid (TXA) in elderly patients with femoral neck fracture undergoing hip arthroplasty.
Methods
We performed search using Pubmed, EMBASE, Cochrane Reviews, and Web of Science databases
to identify all relevant research studies published from inception to June 2022. Randomized
controlled studies and high-quality cohort studies that reported the perioperative
use of TXA in patients with femoral neck fractures treated with arthroplasty, and
made a comparison with the control group were included. Meta-analysis was performed
using Review Manager 5.3 to assess the efficacy and safety of TXA. Subgroup analysis
was conducted to further investigate the impact caused by surgery types and administration
routes on the efficacy and safety outcomes.
Results
Five randomized controlled trials (RCTs) and eight cohort studies published from January
2015 to June 2022 were included in this meta-analysis. The results showed significant
reductions in the rate of allogeneic blood transfusion, total blood loss (TBL) and
postoperative hemoglobin (Hb) drop in the TXA group compared with the control group,
while no significant difference was found in the intraoperative blood loss, postoperative
drainage, hospital length of stay (LOS), re-admission rate, and wound complications
between the two groups. The incidence of thromboembolic events and mortality showed
no significant difference. Subgroup analysis indicated that surgery types and administration
routes did not change the overall tendency.
Conclusion
The current evidence shows that both intravascular administration (IV) and topical
administration of TXA can significantly decrease the perioperative transfusion rate
and TBL without increasing the risk of thromboembolic complications in elderly patients
with femoral neck fracture.
Keywords
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Article info
Publication history
Published online: February 14, 2023
Accepted:
January 16,
2023
Received in revised form:
January 14,
2023
Received:
September 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.
