Tranexamic Acid in Orthopaedic Trauma Surgery: A meta-analysis

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Abstract

Aim:

To systematically review and quantify the efficacy of tranexamic acid (TXA) use in reducing the risk of receiving a blood transfusion in patients undergoing orthopaedic trauma surgery, in reducing blood loss, and risk of thromboembolic events.

Methods:

A systematic literature search was performed using Medline, Embase, ClinicalTrials.gov, and conference proceeding abstracts from 2014-2016. A minimum of 2 reviewers screened each study and graded quality. The primary outcome measure was the risk of receiving a blood transfusion in the TXA group versus control. A meta-analysis was performed to construct a combined odds ratio (OR) of receiving a blood transfusion, mean difference (MD) of blood loss, and OR of thromboembolic events.

Results:

Sixteen studies met inclusion criteria and 12 contained sufficient data to be included in the quantitative analysis (1,333 patients). The risk of blood transfusion was significantly less in patients who were administered TXA compared to controls (OR 0.407; 95% confidence interval (CI) 0.278-0.594, I2=34, Q=17, p=<0.001). There was significantly less blood loss in the TXA group compared to controls, as the mean difference was 304 mL (95% CI 142-467 mL) (I2=94, Q-value=103, p <0.001). There was no significant difference in risk of symptomatic thromboembolic events (OR 0.968; 95% CI 0.530-1.766, I2=0, Q-value=5, p =0.684).

Conclusion:

In orthopaedic trauma patients, TXA reduces the risk of blood transfusion, reduces perioperative blood loss, and has no significant effect on the risk of symptomatic thromboembolic events. More high-quality studies are needed to ensure the safety of the drug in these patients.

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