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European Journal of Trauma and Emergency Surgery

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13-12-2022 | Tranexamic Acid | Review Article

Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis

Authors: Simone Augustinus, Marjolein A. M. Mulders, Tjibbe J. Gardenbroek, J. Carel Goslings

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

Abstract

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.

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Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573–9. https://doi.org/10.1001/jama.2009.1462.CrossRefPubMedPubMedCentral

Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop. 2014;5(4):402–11. https://doi.org/10.5312/wjo.v5.i4.402.CrossRefPubMedPubMedCentral

Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing. 2008;37(2):173–8. https://doi.org/10.1093/ageing/afm161.CrossRefPubMed

Mosk CA, Mus M, Vroemen JP, et al. Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging. 2017;12:421–30. https://doi.org/10.2147/CIA.S115945.CrossRefPubMedPubMedCentral

Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113(15):3406–17. https://doi.org/10.1182/blood-2008-10-167643.CrossRefPubMed

Cuesta-Peredo D, Arteaga-Moreno F, Belenguer-Varea Á, et al. Influence of hospital adverse events and previous diagnoses on hospital care cost of patients with hip fracture. Arch Osteoporos. 2019;14(1):88. https://doi.org/10.1007/s11657-019-0638-6.CrossRefPubMed

Fillingham YA, Ramkumar DB, Jevsevar DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct meta-analysis. J Arthroplasty. 2018;33(10):3070-3082.e1. https://doi.org/10.1016/j.arth.2018.03.031.CrossRefPubMed

Jiang X, Ma X-L, Ma J-X. Efficiency and safety of intravenous tranexamic acid in simultaneous bilateral total knee arthroplasty: a systematic review and meta-analysis. Orthop Surg. 2016;8(3):285–93. https://doi.org/10.1111/os.12256.CrossRefPubMedPubMedCentral

Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Jt Surg Br. 2011;93(1):39–46. https://doi.org/10.1302/0301-620X.93B1.24984.CrossRef

10.

Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord. 2015;16:229. https://doi.org/10.1186/s12891-015-0696-x.CrossRefPubMedPubMedCentral

11.

Smith GH, Tsang J, Molyneux SG, White TO. The hidden blood loss after hip fracture. Injury. 2011;42(2):133–5. https://doi.org/10.1016/j.injury.2010.02.015.CrossRefPubMed

12.

Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Jt Surg Br. 2006;88(8):1053–9. https://doi.org/10.1302/0301-620X.88B8.17534.CrossRef

13.

Lee C, Freeman R, Edmondson M, Rogers BA. The efficacy of tranexamic acid in hip hemiarthroplasty surgery: an observational cohort study. Injury. 2015;46(10):1978–82. https://doi.org/10.1016/j.injury.2015.06.039.CrossRefPubMed

14.

Kwak DK, Jang CY, Kim DH, Rhyu SH, Hwang JH, Yoo JH. Topical tranexamic acid in elderly patients with femoral neck fractures treated with hemiarthroplasty: efficacy and safety? A case-control study. BMC Musculoskelet Disord. 2019;20(1):1–9. https://doi.org/10.1186/s12891-019-2615-z.CrossRef

15.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

16.

Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898. https://doi.org/10.1136/bmj.l4898.CrossRefPubMed

17.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6. https://doi.org/10.1046/j.1445-2197.2003.02748.x.CrossRefPubMed

18.

Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. https://doi.org/10.1186/1471-2288-14-135.CrossRefPubMedPubMedCentral

19.

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186.CrossRefPubMed

20.

Narkbunnam R, Chompoonutprapa A, Ruangsomboon P, Udomkiat P, Chareancholvanich K, Pornrattanamaneewong C. Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: a randomized controlled trial. Injury. 2021;52(10):2986–90. https://doi.org/10.1016/j.injury.2021.08.001.CrossRefPubMed

21.

Nikolaou VS, Masouros P, Floros T, Chronopoulos E, Skertsou M, Babis GC. Single dose of tranexamic acid effectively reduces blood loss and transfusion rates in elderly patients undergoing surgery for hip fracture: a randomized controlled trial. Bone Joint J. 2021;103-B(3):442–448. https://doi.org/10.1302/0301-620X.103B3.BJJ-2020-1288.R1

22.

Thipparampall AK, Gurajala I, Gopinath R. The effect of different dose regimens of tranexamic acid in reducing blood loss during hip surgery. Indian J Anaesth. 2017;61(3):235–9. https://doi.org/10.4103/ija.IJA_495_16.CrossRefPubMedPubMedCentral

23.

Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res. 2014;8(1):48–53. https://doi.org/10.4103/0259-1162.128908.CrossRefPubMedPubMedCentral

24.

Ashkenazi I, Schermann H, Gold A, et al. Tranexamic acid in hip hemiarthroplasty. Injury. 2020;51(11):2658–62. https://doi.org/10.1016/j.injury.2020.07.061.CrossRefPubMed

25.

Cheung ZB, Anthony SG, Forsh DA, et al. Utilization, effectiveness, and safety of tranexamic acid use in hip fracture surgery: a population-based study. J Orthop. 2020;20:167–72. https://doi.org/10.1016/j.jor.2020.01.040.CrossRefPubMedPubMedCentral

26.

Kahan JB, Morris J, Li D, Moran J, O’Connor MI. Expanded use of tranexamic acid is safe and decreases transfusion rates in patients with geriatric hip fractures. OTA Int Open Access J Orthop Trauma. 2021;4(4): e147. https://doi.org/10.1097/OI9.0000000000000147.CrossRef

27.

van Rijckevorsel VAJIM, Roukema GR, Kuijper TM, de Jong L. Clinical outcomes of tranexamic acid in acute hip hemiarthroplasties in frail geriatric patients. Orthop Traumatol Surg Res. 2022;108(5):103219. https://doi.org/10.1016/j.otsr.2022.103219.CrossRefPubMed

28.

Viberg B, Gundtoft PH, Schønnemann JO, et al. Is tranexamic acid use in patients with a hip fracture safe? Bone Jt J. 2021;103-B(3):449–55. https://doi.org/10.1302/0301-620X.103B3.BJJ-2020-1375.R2.CrossRef

29.

Xie J, Hu Q, Huang Q, Chen G, Zhou Z, Pei F. Efficacy and safety of tranexamic acid in geriatric hip fracture with hemiarthroplasty: a retrospective cohort study. BMC Musculoskelet Disord. 2019;20(1):1–9. https://doi.org/10.1186/s12891-019-2670-5.CrossRef

30.

Liu W, Hui H, Zhang Y, Lin W, Fan Y. Intra-articular tranexamic acid injection during the hip hemi-arthroplasty in elderly patients: a retrospective study. Geriatr Orthop Surg Rehabil. 2018;9:215145931880385. https://doi.org/10.1177/2151459318803851.CrossRef

31.

Fillingham YA, Ramkumar DB, Jevsevar DS, et al. Tranexamic acid in total joint arthroplasty: the endorsed clinical practice guides of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and. Reg Anesth Pain Med. 2019;44(1):7–11. https://doi.org/10.1136/rapm-2018-000024.CrossRefPubMed

32.

Shichman I, Shaked O, Ashkenazi I, Schwarzkopf R, Warschawski Y, Snir N. Tranexamic acid in non-elective primary total hip arthroplasty. Injury. 2021;52(6):1544–8. https://doi.org/10.1016/j.injury.2020.10.056.CrossRefPubMed

33.

Haj-Younes B, Sivakumar BS, Wang M, An VV, Lorentzos P, Adie S. Tranexamic acid in hip fracture surgery: a systematic review and meta-analysis. J Orthop Surg (Hong Kong). 2020;28(1):2309499019887995. https://doi.org/10.1177/2309499019887995.CrossRefPubMed

34.

Farrow LS, Smith TO, Ashcroft GP, Myint PK. A systematic review of tranexamic acid in hip fracture surgery. Br J Clin Pharmacol. 2016;82(6):1458–70. https://doi.org/10.1111/bcp.13079.CrossRefPubMedPubMedCentral

35.

Qi Y-M, Wang H-P, Li Y-J, et al. The efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis. J Orthop Transl. 2019;19:1–11. https://doi.org/10.1016/j.jot.2019.03.007.CrossRef

36.

Xing F, Chen W, Long C, Huang F, Wang G, Xiang Z. Postoperative outcomes of tranexamic acid use in geriatric trauma patients treated with proximal femoral intramedullary nails: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2020;106(1):117–26. https://doi.org/10.1016/j.otsr.2019.10.015.CrossRefPubMed

37.

Luo X, Huang H, Tang X. Efficacy and safety of tranexamic acid for reducing blood loss in elderly patients with intertrochanteric fracture treated with intramedullary fixation surgery: a meta-analysis of randomized controlled trials. Acta Orthop Traumatol Turc. 2020;54(1):4–14. https://doi.org/10.5152/j.aott.2020.01.88.CrossRefPubMedPubMedCentral

38.

Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hong Kong). 2016;24(3):379–82. https://doi.org/10.1177/1602400322.CrossRefPubMed

39.

Yoon B-H, Kim T-Y, Ko YS, Lee Y-K, Ha Y-C, Koo K-H. Optimal use of tranexamic acid for total hip arthroplasty: a network meta-analysis. PLoS One. 2018;13(10): e0206480. https://doi.org/10.1371/journal.pone.0206480.CrossRefPubMedPubMedCentral

40.

Xiong H, Liu Y, Zeng Y, Wu Y, Shen B. The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2018;19(1):321. https://doi.org/10.1186/s12891-018-2181-9.CrossRefPubMedPubMedCentral

41.

Li Z-J, Fu X, Xing D, Zhang H-F, Zang J-C, Ma X-L. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2013;22(9):1950–7. https://doi.org/10.1007/s00586-013-2774-9.CrossRef

42.

Porter SB, Spaulding AC, Duncan CM, Wilke BK, Pagnano MW, Abdel MP. Tranexamic acid was not associated with increased complications in high-risk patients with hip fracture undergoing arthroplasty. J Bone Jt Surg Am. 2021;103(20):1880–9. https://doi.org/10.2106/JBJS.21.00172.CrossRef

43.

Jules-Elysee KM, Tseng A, Sculco TP, et al. Comparison of topical and intravenous tranexamic acid for total knee replacement: a randomized double-blinded controlled study of effects on tranexamic acid levels and thrombogenic and inflammatory marker levels. J Bone Jt Surg Am. 2019;101(23):2120–8. https://doi.org/10.2106/JBJS.19.00258.CrossRef

44.

Jiganti M, Pipitone O, Than J, Stanley R, Passanise A, Krumrey J. A single dose versus two doses of tranexamic acid for extracapsular hip fractures. Cureus. 2022;14(1): e21239. https://doi.org/10.7759/cureus.21239.CrossRefPubMedPubMedCentral

45.

Li C, Zhang W, Chang Q, Li Y. Combination effect of intraoperative and postoperative intravenous tranexamic acid in hip hemiarthroplasty. A propensity score matched analysis. Injury. 2022;53(10):3401–6. https://doi.org/10.1016/j.injury.2022.07.033.CrossRefPubMed

46.

Carson JL, Stanworth SJ, Dennis JA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021;12:CD002042. https://doi.org/10.1002/14651858.CD002042.pub5.CrossRefPubMed

47.

Sim YE, Sim S-ED, Seng C, Howe TS, Koh SB, Abdullah HR. Preoperative anemia, functional outcomes, and quality of life after hip fracture surgery. J Am Geriatr Soc. 2018;66(8):1524–31. https://doi.org/10.1111/jgs.15428.CrossRefPubMed

Title: Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis
Authors: Simone Augustinus
Marjolein A. M. Mulders
Tjibbe J. Gardenbroek
J. Carel Goslings
Publication date: 13-12-2022
Publisher: Springer Berlin Heidelberg
Keywords: Tranexamic Acid
Hip-TEP
Hip-TEP
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02180-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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