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- Title
The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trials.
- Authors
Tang, Xiumei; Li, Kai; Zheng, Fuyuan; He, Yue; Yang, Yang; Wang, Duan
- Abstract
Background: Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, delaying fibrinolysis and blood clot degradation. However, the effect of TXA on patients with calcaneal surgery remains controversial. Our objective was to evaluate the effectiveness of TXA in calcaneal fractures surgeries. Methods: The electronic literature databases of Pubmed, Embase, and Cochrane library were searched in December 2022. The data on blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication were extracted. The Stata 22.0 software was used for the meta-analysis. Results: Four randomized controlled studies met our inclusion criteria. This meta-analysis showed that TXA significantly reduced postoperative blood loss during the first 24 h (p < 0.001), improved the level of hemoglobin (p < 0.001) and hematocrit (p = 0.03), and reduced the risk of wound complications (p = 0.04). There was no significant difference between the two groups regarding total and intraoperative blood loss, hospital stay, duration of surgery, platelet count, activated partial thromboplastin time, and prothrombin time. Conclusion: TXA significantly reduced blood loss during the first 24 h postoperatively, improved the level of hemoglobin and hematocrit, and reduced the risk of wound complications. Given the evidence, TXA can be used in patients with calcaneal fractures and had the potential benefit of blood reduction. Protocol registration: The protocol was registered in PROSPERO (registration No. CRD42023391211). Highlights: As we know, this is the first meta-analysis to focus on the safety and effectiveness of tranexamic acid (TXA) in the fields of calcaneal fracture surgeries which include percutaneous screw fixation, open reduction, and internal fixation. Our study was prospectively registered on the PROSPERO website. The search was conducted without any language restrictions and the results were reported according to the PRISMA checklist. The quality of evidence was assessed using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) system. Thus, we yield a comprehensive group of eligible studies and dependable results for our conclusion. In this meta-analysis and systematic review, TXA significantly reduced blood loss during the first 24 h postoperatively, improved the levels of hemoglobin and hematocrit, and reduced the risk of wound complications. In view of the evidence, TXA can be safely used in patients with calcaneal fractures and had the potential benefit of blood reduction.
- Subjects
PREVENTION of surgical complications; HEMORRHAGE prevention; DRUG efficacy; SURGICAL blood loss; ONLINE information services; MEDICAL databases; LENGTH of stay in hospitals; META-analysis; MEDICAL information storage &; retrieval systems; HEMOGLOBINS; HEMATOCRIT; SYSTEMATIC reviews; OPEN reduction internal fixation; TRANEXAMIC acid; HEEL bone fractures; FRACTURE fixation; DESCRIPTIVE statistics; RESEARCH funding; MEDLINE; DATA analysis software; PREANESTHETIC medication; EVALUATION
- Publication
Journal of Orthopaedic Surgery & Research, 2023, Vol 18, Issue 1, p1
- ISSN
1749-799X
- Publication type
Article
- DOI
10.1186/s13018-023-03924-0