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Tranexamic Acid in Orthopaedic Trauma Surgery: A Meta-Analysis

Gausden, Elizabeth B. MD*; Qudsi, Rameez MD; Boone, Myles D. MD; O'Gara, Brian MD; Ruzbarsky, Joseph J. MD*; Lorich, Dean G. MD§

doi: 10.1097/BOT.0000000000000913
Original Article
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Aim: To systematically review and quantify the efficacy of tranexamic acid (TXA) use in reducing the risk of receiving a blood transfusion in patients undergoing orthopaedic trauma surgery, in reducing blood loss, and risk of thromboembolic events.

Methods: A systematic literature search was performed using MEDLINE, Embase, ClinicalTrials.gov, and conference proceeding abstracts from 2014 to 2016. A minimum of 2 reviewers screened each study and graded quality. The primary outcome measure was the risk of receiving a blood transfusion in the TXA group versus control. A meta-analysis was performed to construct a combined odds ratio (OR) of receiving a blood transfusion, mean difference (MD) of blood loss, and OR of thromboembolic events.

Results: Twelve studies were included in the quantitative analysis (1,333 patients). The risk of blood transfusion was significantly less in patients who were administered TXA compared with controls [OR 0.407; 95% confidence interval (CI) 0.278–0.594, I2 = 34, Q = 17, P ≤ 0.001]. There was significantly less blood loss in the TXA group compared with controls, as the mean difference was 304 mL (95% CI, 142–467 mL) (I2 = 94, Q value = 103, P < 0.001). There was no significant difference in risk of symptomatic thromboembolic events (OR 0.968; 95% CI, 0.530–1.766, I2 = 0, Q value = 5, P = 0.684).

Conclusions: In patients with orthopaedic trauma, TXA reduces the risk of blood transfusion, reduces perioperative blood loss, and has no significant effect on the risk of symptomatic thromboembolic events. More high-quality studies are needed to ensure the safety of the drug in these patients.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

*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.

Reprints: Elizabeth B. Gausden, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St. 8th Floor, New York, NY 10021 (e-mail: gausdene@hss.edu).

This study was funded by the Samuel and May Rudin Foundation.

The authors report no conflict of interest.

Tranexamic acid use in preventing blood loss in fracture surgery is not FDA approved and is off-label use.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Accepted May 11, 2017

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