A systematic review of Tranexamic acid in hip fracture surgery

Research output: Contribution to journalArticle

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Abstract

Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery. Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach. Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95% CI: 0.35 to 0.85; I2: 78%; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95% CI: 0.45 to 1.18; I2: 46%; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95% CI: -0.03, 0.05; I2: 68%; Inconsistency (Chi2) p=0.007, N=683). Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.
Original languageEnglish
Pages (from-to)1458-1470
Number of pages13
JournalBritish Journal of Clinical Pharmacology
Volume82
Issue number6
Early online date4 Aug 2016
DOIs
Publication statusPublished - Dec 2016

Fingerprint

Tranexamic Acid
Hip Fractures
Blood Transfusion
Meta-Analysis
Odds Ratio
Placebos
Orthopedic Procedures
Risk Reduction Behavior
Observational Studies
Registries
Hemoglobins
Outcome Assessment (Health Care)
Safety
Control Groups

Keywords

  • bleeding
  • femoral neck fracture
  • hip fracture
  • meta-analysis
  • orthopaedics
  • surgery
  • systematic review
  • tranexamic acid
  • transfusion
  • trauma

Cite this

A systematic review of Tranexamic acid in hip fracture surgery. / Farrow, L S; Smith, T O; Ashcroft, G P; Myint, P K.

In: British Journal of Clinical Pharmacology, Vol. 82, No. 6, 12.2016, p. 1458-1470.

Research output: Contribution to journalArticle

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title = "A systematic review of Tranexamic acid in hip fracture surgery",
abstract = "Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery. Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach. Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46{\%} risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95{\%} CI: 0.35 to 0.85; I2: 78{\%}; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95{\%} CI: 0.45 to 1.18; I2: 46{\%}; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95{\%} CI: -0.03, 0.05; I2: 68{\%}; Inconsistency (Chi2) p=0.007, N=683). Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.",
keywords = "bleeding, femoral neck fracture, hip fracture, meta-analysis, orthopaedics , surgery, systematic review, tranexamic acid, transfusion, trauma",
author = "Farrow, {L S} and Smith, {T O} and Ashcroft, {G P} and Myint, {P K}",
note = "COMPETING INTERESTS & FINANCIAL SUPPORT “All authors have completed the Unified Competing Interest form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work”",
year = "2016",
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T1 - A systematic review of Tranexamic acid in hip fracture surgery

AU - Farrow, L S

AU - Smith, T O

AU - Ashcroft, G P

AU - Myint, P K

N1 - COMPETING INTERESTS & FINANCIAL SUPPORT “All authors have completed the Unified Competing Interest form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work”

PY - 2016/12

Y1 - 2016/12

N2 - Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery. Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach. Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95% CI: 0.35 to 0.85; I2: 78%; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95% CI: 0.45 to 1.18; I2: 46%; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95% CI: -0.03, 0.05; I2: 68%; Inconsistency (Chi2) p=0.007, N=683). Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.

AB - Aim: To systematically examine and quantify the efficacy and safety of Tranexamic acid in hip fracture surgery. Methods: A systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration’s risk of bias tool for RCT’s and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes respectively. The interpretation of each outcome was made using the GRADE approach. Results: Of 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On meta-analysis, intra-venous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR:0.54; 95% CI: 0.35 to 0.85; I2: 78%; Inconsistency (Chi2) p=<0.0001; N=750). There was also a significantly higher post-operative haemoglobin for TXA versus placebo/control (MD:0.81; 95% CI: 0.45 to 1.18; I2: 46%; Inconsistency (Chi2) p=0.10; N=638). There was no increased risk of thromboembolic events (RD:0.01; 95% CI: -0.03, 0.05; I2: 68%; Inconsistency (Chi2) p=0.007, N=683). Conclusion: There is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.

KW - bleeding

KW - femoral neck fracture

KW - hip fracture

KW - meta-analysis

KW - orthopaedics

KW - surgery

KW - systematic review

KW - tranexamic acid

KW - transfusion

KW - trauma

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DO - 10.1111/bcp.13079

M3 - Article

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EP - 1470

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 6

ER -