TY - JOUR
T1 - Tranexamic acid in hip hemiarthroplasty surgery
T2 - a systematic review and meta-analysis
AU - Augustinus, Simone
AU - Mulders, Marjolein A. M.
AU - Gardenbroek, Tjibbe J.
AU - Goslings, J. Carel
N1 - Funding Information: The authors thank Chantal den Haan for her work as a clinical librarian on the search strategy. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/6
Y1 - 2023/6
N2 - Purpose: Anemia is one of the most common complications after hip fracture surgery. Tranexamic acid (TXA) has been considered effective in preventing anemia in total hip arthroplasty, but its role in hemiarthroplasty is debated. The aim of this systematic review was to investigate the efficacy and safety of perioperative TXA for hip hemiarthroplasty. Methods: A systematic literature search was performed to identify studies comparing adult patients who underwent hemiarthroplasty for a hip fracture with and without perioperative TXA. The primary outcome was transfusion rate. Secondary outcomes included postoperative hemoglobin, length of hospital stay, adverse events (i.e., deep venous thromboses and pulmonary embolism), and 30-day mortality. Results: In total, 13 articles were included, comprising 54,843 patients of whom 14.1% received perioperative TXA. TXA was applied intravenous in ten studies, topical in two studies, one study investigated both. Pooled results showed a significant reduction in transfusion rate (pooled RR: 0.48, 95% CI 0.40–0.58, p < 0.01). Postoperative hemoglobin and length of stay were investigated in nine studies, pooled results showed significant improvement of both outcomes for patients that received TXA. Eleven studies investigated thromboembolic events, and there was no statistical difference in deep venous thromboses (pooled RR: 0.67, 95% CI 0.18–2.56, p = 0.56) or pulmonary embolism (pooled RR: 1.10, 95% CI 0.45–2.68, p = 0.83) among the two groups. There was a significant reduction in 30-day mortality for patients that received TXA. Conclusion: TXA can be considered effective and safe for patients undergoing hip hemiarthroplasty, with a reduction in transfusion rate and increase in postoperative hemoglobin, without increasing adverse events. Optimal timing, dosage, and type of administration of TXA remain unclear.
AB - Purpose: Anemia is one of the most common complications after hip fracture surgery. Tranexamic acid (TXA) has been considered effective in preventing anemia in total hip arthroplasty, but its role in hemiarthroplasty is debated. The aim of this systematic review was to investigate the efficacy and safety of perioperative TXA for hip hemiarthroplasty. Methods: A systematic literature search was performed to identify studies comparing adult patients who underwent hemiarthroplasty for a hip fracture with and without perioperative TXA. The primary outcome was transfusion rate. Secondary outcomes included postoperative hemoglobin, length of hospital stay, adverse events (i.e., deep venous thromboses and pulmonary embolism), and 30-day mortality. Results: In total, 13 articles were included, comprising 54,843 patients of whom 14.1% received perioperative TXA. TXA was applied intravenous in ten studies, topical in two studies, one study investigated both. Pooled results showed a significant reduction in transfusion rate (pooled RR: 0.48, 95% CI 0.40–0.58, p < 0.01). Postoperative hemoglobin and length of stay were investigated in nine studies, pooled results showed significant improvement of both outcomes for patients that received TXA. Eleven studies investigated thromboembolic events, and there was no statistical difference in deep venous thromboses (pooled RR: 0.67, 95% CI 0.18–2.56, p = 0.56) or pulmonary embolism (pooled RR: 1.10, 95% CI 0.45–2.68, p = 0.83) among the two groups. There was a significant reduction in 30-day mortality for patients that received TXA. Conclusion: TXA can be considered effective and safe for patients undergoing hip hemiarthroplasty, with a reduction in transfusion rate and increase in postoperative hemoglobin, without increasing adverse events. Optimal timing, dosage, and type of administration of TXA remain unclear.
KW - Hemiarthroplasty
KW - Hip fracture
KW - Systematic review and meta-analysis
KW - Tranexamic acid
UR - http://www.scopus.com/inward/record.url?scp=85143916125&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00068-022-02180-x
DO - https://doi.org/10.1007/s00068-022-02180-x
M3 - Review article
C2 - 36512031
SN - 1863-9933
VL - 49
SP - 1247
EP - 1258
JO - European journal of trauma
JF - European journal of trauma
IS - 3
ER -