Tranexamic acid and its outcomes in foot and ankle surgical procedures: A meta-analysis

As the indication for Tranexamic Acid (TXA) evolves, this study serves as a comprehensive review of the literature evaluating the impact of TXA in foot and ankle surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to evaluate TXA benefits and safety profile in foot and ankle surgery. Inclusion criteria included TXA use in foot and ankle surgery with at least one of the outcomes: wound complications, infections, postoperative bleeding, and risk of thromboembolic events (VTEs). MEDLINE/PubMed and Cochrane Library were searched for eligible studies from inception through April 1st, 2023, utilizing keywords: tranexamic acid with any combination of calcaneal, foot and ankle, total ankle arthroplasty. Risk of bias was assessed by Cochrane Robvis and ROBIN-1 tools. Cochrane Review Manager synthesized individual study data. Of 36 studies reviewed, 7 met inclusion criteria. There was a total of 691 subjects between the two groups: TXA (n = 338) and non-TXA (n = 353). Though statistically not significant, wound complications and postoperative infections were lower in the TXA group compared to non-TXA (15.4 % versus 26.1 %, p = 0.21) and (4.9 % vs. 9.4 %, p = 0.20), respectively. The TXA group experienced statistically lower blood loss compared to the non-TXA group (149 vs. 156 ml, p = 0.002), and showed a lower hemoglobin drop level (122 vs. 138, p = 0.005). TXA use in foot and ankle surgery demonstrated a trend towards lower overall wound complications, risk of infections, risk of postoperative bleeding, with no increased risk for VTEs.