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Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis

AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospecti...

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Autores principales: Miangul, Shahid, Oluwaremi, Timothy, El Haddad, Joe, Adra, Maamoun, Pinnawala, Nathan, Nakanishi, Hayato, Matar, Reem H., Than, Christian A., Stewart, Thomas M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10275812/
https://www.ncbi.nlm.nih.gov/pubmed/36156738
http://dx.doi.org/10.1007/s00590-022-03387-9
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author Miangul, Shahid
Oluwaremi, Timothy
El Haddad, Joe
Adra, Maamoun
Pinnawala, Nathan
Nakanishi, Hayato
Matar, Reem H.
Than, Christian A.
Stewart, Thomas M.
author_facet Miangul, Shahid
Oluwaremi, Timothy
El Haddad, Joe
Adra, Maamoun
Pinnawala, Nathan
Nakanishi, Hayato
Matar, Reem H.
Than, Christian A.
Stewart, Thomas M.
author_sort Miangul, Shahid
collection PubMed
description AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS: Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD =  − 196.91 mL, 95% CI − 247.59, − 146.23, I(2) = 92%), intraoperative blood loss (MD = − 26.86 mL, 95% CI − 36.96, − 16.78, I(2) = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I(2) = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I(2) = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I(2) = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I(2) = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I(2) = 0%). CONCLUSION: Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00590-022-03387-9.
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spelling pubmed-102758122023-06-18 Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis Miangul, Shahid Oluwaremi, Timothy El Haddad, Joe Adra, Maamoun Pinnawala, Nathan Nakanishi, Hayato Matar, Reem H. Than, Christian A. Stewart, Thomas M. Eur J Orthop Surg Traumatol Up-to date Review and Case Report AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS: Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD =  − 196.91 mL, 95% CI − 247.59, − 146.23, I(2) = 92%), intraoperative blood loss (MD = − 26.86 mL, 95% CI − 36.96, − 16.78, I(2) = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I(2) = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I(2) = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I(2) = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I(2) = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I(2) = 0%). CONCLUSION: Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00590-022-03387-9. Springer Paris 2022-09-26 2023 /pmc/articles/PMC10275812/ /pubmed/36156738 http://dx.doi.org/10.1007/s00590-022-03387-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Up-to date Review and Case Report
Miangul, Shahid
Oluwaremi, Timothy
El Haddad, Joe
Adra, Maamoun
Pinnawala, Nathan
Nakanishi, Hayato
Matar, Reem H.
Than, Christian A.
Stewart, Thomas M.
Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title_full Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title_fullStr Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title_full_unstemmed Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title_short Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
title_sort update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis
topic Up-to date Review and Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10275812/
https://www.ncbi.nlm.nih.gov/pubmed/36156738
http://dx.doi.org/10.1007/s00590-022-03387-9
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