Medicine (Baltimore). 2019 Mar;98(11):e14564

# Tranexamic acid can reduce blood loss in patients undergoing intertrochanteric fracture surgery: A meta-analysis.

Jiang W, Shang L.

BACKGROUND: This meta-analysis aimed to assess whether administration tranexamic acid (TXA) could reduce blood loss and transfusion requirements in patients undergoing intertrochanteric fracture surgery.

METHODS: We performed an electronic search of PubMed (1950-October 2018), EMBASE (1974-October 2018), the Cochrane Library (October 2018 Issue 3), the Google database (1950-October 2018), and the Chinese Wanfang database (1950-October 2018). Studies were included in accordance with Population, Intervention, Comparison, Outcomes, and Setting (PICOS) including criteria. Intertrochanteric fracture patients prepared for surgery were selected. Administration with TXA and the placebo or no interventions were considered as an intervention and comparators, respectively. Measures related to total blood loss, blood loss in drainage, hemoglobin on postoperative day were analyzed. A fixed/random-effects model was used according to the heterogeneity assessed by the I statistic. Data analysis was performed using Stata 12.0 software.

RESULTS: A total of five RCTs with 584 patients (TXA group = 289, control group = 298) were included in the meta-analysis. Based on the results, administration of TXA was associated with a reduction in total blood loss, blood loss in drainage, need for transfusion, length of hospital stay, and occurrence of hematoma (P < .05). Administration of TXA increased the hemoglobin level at 3 days after surgery (P < .05). There were no significant differences between the two groups in terms of the occurrence of deep venous thrombosis, pulmonary embolism, or infection (P > .05).

CONCLUSION: Administration of TXA is associated with reduced total blood loss, postoperative hemoglobin decline, and transfusion requirements in patients with intertrochanteric fractures. Additional high-quality RCTs should be conducted in the future.