Intraoperative use of tranexamic acid in the control of bleeding in long bone fracture surgeries: a meta-analysis

Abstract

Tranexamic acid (TXA) has been used successfully in the practice of orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. The use of TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change and hospital-related costs at various degrees. This review aimed to evaluate the clinical results of the intraoperative use of TXA in long bone fracture surgeries. Relevant electronic articles were reviewed through a systematic search and selection process, resulting in the selection of five randomized control trials with a total of 295 participants. These studies compared the primary outcome of this meta-analysis, which was blood loss. Four of the studies included post-operative hemoglobin levels as their outcomes. Furthermore, two studies compared drop in hemoglobin levels, while three studies included blood transfusion events. Results showed a significant difference in terms of total blood loss when intraoperative administration of TXA was compared to placebo in long bone surgeries with a mean difference of -76.94 [-106.62, -47.26] (95% CI) (p≤0.00001). There was no significant difference in terms of post-operative hemoglobin levels (p=0.27) with a mean difference of 0.31 [-0.24, 0.86] (95% CI). No significant difference was also shown between the two groups as to drop in hemoglobin levels (p=0.29) with a mean difference of -0.34 [-0.97, 0.29] (95% CI). This meta-analysis showed that intraoperative use of TXA given during long bone fracture surgeries can effectively reduce total blood loss and reduce risk of transfusion events or avoid transfusion events.