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Tranexamic Acid in Orthopaedic Trauma Surgery: A Meta-Analysis
Elizabeth B Gausden1, Rameez Qudsi, Myles D Boone
1*Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; †Harvard Combined Orthopaedic Residency Program, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; ‡Department of Anesthesiology and Critical Care, Beth Israel Deaconess, Boston, MA; and §Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY.
Tranexamic acid (TXA) significantly reduces blood transfusions and blood loss in orthopedic trauma surgery. This meta-analysis found no increased risk of thromboembolic events, but more research is needed.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Pharmacology
Background:
- Orthopedic trauma surgery is associated with significant blood loss and a high risk of blood transfusions.
- Tranexamic acid (TXA) is an antifibrinolytic agent that may reduce bleeding in surgical settings.
Purpose of the Study:
- To systematically review and quantify the efficacy of tranexamic acid (TXA) in reducing blood transfusions and blood loss in orthopedic trauma patients.
- To assess the risk of thromboembolic events associated with TXA use in this population.
Main Methods:
- A systematic literature search was conducted across multiple databases for studies published between 2014 and 2016.
- A meta-analysis of 12 studies involving 1,333 patients was performed to calculate pooled odds ratios and mean differences.
Main Results:
- TXA significantly reduced the risk of blood transfusion (OR 0.407; 95% CI 0.278-0.594) and perioperative blood loss (MD 304 mL; 95% CI 142-467 mL).
- No significant difference in the risk of symptomatic thromboembolic events was observed between the TXA and control groups (OR 0.968; 95% CI 0.530-1.766).
Conclusions:
- TXA is effective in reducing blood transfusions and blood loss in patients undergoing orthopedic trauma surgery.
- Current evidence suggests TXA does not increase the risk of symptomatic thromboembolic events in this patient group.
- Further high-quality studies are recommended to confirm the safety profile of TXA in orthopedic trauma patients.
