Assessing the Effectiveness of Tranexamic Acid in Hip Fracture Management: A Systematic Review

TL;DR

This review finds that tranexamic acid reduces blood loss and transfusion needs in hip fracture surgery without increasing risks.

Contribution

The study provides a systematic review of TXA's effectiveness in hip fracture management from 2019 to 2024.

Findings

TXA reduced intraoperative and postoperative blood loss by up to 46%.

TXA did not increase thromboembolic complications across various dosing strategies.

Benefits were more pronounced in extracapsular hip fractures.

Abstract

Hip fractures often lead to significant blood loss and transfusion requirements in the older population. Tranexamic acid (TXA) is used to control bleeding, but its optimal dose, timing, and broader clinical benefits remain unclear. A systematic search of PubMed, ScienceDirect, the Cochrane Library, Ovid-EMBASE, and EBSCOhost was performed for studies published between 2019 and 2024. Eligible studies included adults with traumatic hip fractures (intra- or extracapsular) treated with TXA. In total, 14 studies met the inclusion criteria, including randomised controlled trials, cohort studies, and meta-analyses. Findings were synthesised narratively due to heterogeneity in interventions and outcomes. TXA consistently reduced intraoperative and postoperative blood loss and lowered transfusion needs, with reductions up to 46% compared with controls. Across various dosing strategies, i.e., preoperative, divided doses, or topical, no significant increase in thromboembolic complications was reported. Limited but favourable evidence suggested improvements in pain, functional recovery, and hospital stay. Benefits appeared more pronounced in extracapsular fractures, where hidden blood loss is typically greater. TXA is a safe and effective adjunct in hip fracture surgery, significantly reducing blood loss and transfusion requirements without increasing the risk of thromboembolism. Standardised dosing protocols are needed, and further research should focus on long-term recovery and tailoring treatment to the type of fracture and patient characteristics.

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