BACKGROUND: Tranexamic acid has been widely used in joint arthroplasty, which not only reduces perioperative blood loss, but also does not increase the risk of venous thrombus. It is reported that the use of tranexamic acid in the surgery of intertrochanteric fractures has similar effects. However, these studies are small-sample trials, and the results are still controversial. It is necessary to systematically evaluate and analyze the clinical researches about the tranexamic acid on reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
OBJECTIVE: To investigate the effectiveness and safety of tranexamic acid for reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
METHODS: PubMed, Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang databases were searched for the randomized controlled trials and prospective cohort studies addressing tranexamic acid reducing intraoperative and postoperative blood loss of intertrochanteric fracture from inception to October 5, 2018. The literature selection, data extraction, and evaluation of bias risk of the studies were performed independently by two authors. Meta-analysis was conducted using RevMan 5.3 software.
RESULTS AND CONCLUSION: Thirteen studies were enrolled, including 12 randomized controlled trials and 1 prospective cohort, involving 1 353 cases of intertrochanteric fracture (676 in tranexamic acid group, and 677 in placebo group). Meta-analysis results showed that compared with the placebo group, tranexamic acid applied in the surgery of intertrochanteric fractures, could significantly reduce the intraoperative and postoperative total blood loss (MD=-228.92, 95%CI: -300.93 to -156.91, P < 0.000 01), intraoperative blood loss (MD=-23.74, 95%CI: -40.91 to -6.56, P=0.007), the hidden blood loss (MD=-153.36, 95%CI: -179.21 to -127.50, P < 0.000 01) and increase the postoperative hemoglobin (MD=6.9, 95%CI: 5.44 to 8.44, P < 0.000 01), hematocrit levels (MD=1.44, 95%CI: 0.86 to 2.03, P < 0.00001) and reduce the postoperative blood transfusion rate (OR=0.48, 95%CI: 0.36 to 0.63, P < 0.000 01). Additionally, tranexamic acid did not increase the postoperative D-dimer levels (SMD=-0.13, 95%CI: -0.58 to 0.32, P=0.57), or the incidence of venous thrombosis (OR=1.41, 95%CI: 0.79 to 2.52, P=0.24). Tranexamic acid made no effect on the operation time (MD=-0.16, 95% CI: -1.31 to 1.00, P=0.79) and postoperative mortality (OR=1.61, 95%CI: 0.78 to 1.33, P=0.2). These results indicate that it is safe and effective to use tranexamic acid for reducing intraoperative and postoperative blood loss of intertrochanteric fracture. However, multi-center large-sample randomized controlled trials are required to confirm the conclusions, because of limitations in study counts and quality.