A Meta-analysis Of Tranexamic Acid Usage In Patients Undergoing Hip Fracture Surgery

Background: Hip fracture as a common type of fractures frequently results in considerable blood loss,exposing patients to postoperative anemia.Thus,many patients often need blood transfusion postoperatively.In addition,the elderly occupy a large proportion in hip fracture,their own compensation and bone marrow hematopoietic capacity are low,and they are accompanied with double blow of trauma and operation.All of these lead to a higher incidence rate of postoperative anemia and blood transfusion.These patients are more likely to have postoperative anemia and higher risk of thrombosis after surgery than non-traumatic total hip replacement patients.Now,tranexamic acid(TXA)has been widely used to decrease blood loss and transfusion rates in joint replacement surgery which acts as an antifibrinolytic drug.Though some scholars have questioned the safety of TXA,especially in the aspect of thrombosis,a large number of literatures has proved its effectiveness and safety.They pointed out that TXA can reduce blood loss and transfusion rate without increasing risk of thrombosis risk.However,it is still a controversy whether tranexamic acid usage in hip fracture surgery is safe and effective,especially the safety of its usage in the elderly.There was a very lack of evidence on it.Therefore,we conducted current meta-analysis to evaluate efficacy and safety of tranexamic acid usage in patients undergoing hip fracture surgery,in order to provide a guidance for its usage in clinical treatment.Methods: Relative studies were searched through Cochrane Library,Embase,Pub Med,and Web of science before February 2018.Studies involving the efficacy and safety of TXA usage in patients who underwent hip surgery were included in our research.The suitable studies were contained according to the inclusion and exclusion criterias.The quality evaluation and the collection of relevant data were performed subsequently.Finally,a meta-analysis was performed on the followings endpoints: total blood loss,post-operative hemoglobin decline,transfusion rates,rate of thromboembolic events,mortality(including 30-day mortality and 90-day mortality),operative time,hospital stay and rate of wound complication.Current paper was performed following the guidelines of the Cochrane Reviewer’s Handbook and the PRISMA statement.The pooling of data was carried out by using stata14.0 software.Result: Twelve articles were included in current meta-analysis,involving 1392 participants.Ten studies concerning intravenous(IV)administration of TXA and three studies concerning topical administration of TXA were included.There were 462 patients in the IV TXA group and 187 patients in the topical TXA group.Concerning IV application of TXA,current paper indicated that IV TXA group had less total blood loss[WMD=-280.575,95%CI:(-397.909,-163.241),P= 0.000],lower post-operative hemoglobin decline[WMD=-0.844,95%CI:(-1.225,-0.463),P= 0.000] and lower transfusion rates [RD=-0.165,95%CI(-0.219,-0.112),P=0.000] compared to control group.No significant differences were found regarding the rate of thromboembolic events[RD=0.011,95%CI(-0.016,0.037),P=0.428],30-day mortality [RD=0.001,95%CI(-0.027,0.03),P=0.924],90-day mortality [RD=0.020,95%CI(-0.042,0.082),P=0.534],operative time [WMD=-2.385,95%CI(-6.156,1.386),P=0.215],hospital stay [WMD=-0.982,95%CI(-2.041,0.077),P=0.069] and rate of wound complication [RD=0.007,95%CI(-0.04,0.055),P=0.768].Regarding topical administration of TXA,no significant differences were found regarding transfusion rates [RD=-0.098,95%CI(-0.225,0.029),P=0.129],post-operative hemoglobin decline [WMD=-1.137,95%CI(-2.999,0.725),P=0.231],the rate of thromboembolic events [RD=-0.017,95%CI(-0.091,0.058),P=0.66] and operative time [WMD=-4.842,95%CI(-11.214,1.530),P=0.136]compared to control group.Conclusion: Intravenous administration of tranexamic acid could reduce transfusion rates without increased rate of thromboembolic events and short-term mortality in hip fracture surgery.Though topical administration of tranexamic acid showed no significant effect,it could reduce transfusion rates in hip fracture surgery to some extent and it also had no increase in the rate of thromboembolic events and 1-year mortality.However,the optimal route of administration,TXA dosage,and timing still are still in controversy.In addition,high-quality randomized controlled studies with large sample size are required to figure out the safety of TXA application especially its usage in the elderly before its widely recommendation.