The Efficacy And Safety Of The Utilization Of Intravenous Tranexamic Acid In Geriatric Patients With Hip Fracture Undergoing Hip Surgeries

Objective:To conduct a retrospective analysis of blood loss during the perioperative period of elderly patients with different types of hip fractures so as to analyse the necessity of perioperative blood management in elderly patients with hip fracture,and to conducted a meta-analysis to compare the efficacy and safety of intravenous application of tranexamic acid with placebo in hip fracture patients undergoing hip surgeries.Methods:According to the inclusion and exclusion criteria,patients suffering from hip fractures who underwent surgeries in the orthopedics department in our hospital from October 2016 to October2017 were enrolled to collect preoperative hemoglobin,preoperative hematocrit,perioperative visible blood loss,postoperative hemoglobin,postoperative hematocrit,perioperative blood transfusion,etc..Then calculation of total blood loss,hidden blood loss,and comparison of the blood loss of each group were conducted.PubMed,Embase and Cochrane Library were searched from inception until March 2018.A combined searching strategy of subject words and random words was adopted.Only randomized clinical trials were included.The comparisons regarding transfusion rate,total blood loss,intraoperative blood loss,postoperative blood loss,postoperativehemoglobin,and postoperative thromboembolic complications were conducted.The meta-analysis was performed with the Review manager 5.3,and the bias evaluation was based on the Cochrane Handbook 5.1.0.Results:Patients with intertrochanteric fracture had lower preoperative Hb(108.08g/L)than patients undergoing THA(125.61g/L)and HA(118.86g/L)(P=0.000)and lower postoperative Hb(88.68g/Lg/L)than patients undergoing THA(97.06g/L)and HA(96.54g/L)(P=0.001).The total blood loss of different surgical methods was compared: intramedullary nail fixation(1431.9ml)>THA(1240.6ml)>HA(807.4ml)(P=0.000).The differences between the three groups were statistically significant.The hidden blood loss was 757.9±147.0ml in the THA group,which was significantly higher than that in the HA group(504.4±148.5ml).The visible blood loss in the THA group was 482.8±133.7ml,which was also significantly higher than the HA group(303.0 ± 130.5ml).The hidden blood loss in the THA group accounted for 61% of the total blood loss,and the hidden blood loss in the HA group accounted for 62.4% of the total blood loss.10 Randomized controlled trials published between 2007 to 2018 were included in the meta-analysis.The results showed that there were significant differences in the two groups concerning transfusion rate of allogeneic blood(RR=0.66,95% CI: 0.51 to 0.87,P=0.003),total blood loss(MD=-273.00,95%CI:-353.15 to-192.84,P<0.00001),intraoperative blood loss(MD=-76.63,95% CI:-139.55 to-13.71,P=0.02),postoperative blood loss(MD=-125.29,95% CI:-221.96 to-28.62,P=0.01),and postoperative hemoglobin(MD=0.80,95% CI: 0.38 to 1.22,P=0.0002).Non-significant differences were found in the incidence of thromboembolic events(RR=1.38,95% CI: 0.74 to2.55,P=0.31).Conclusion:Patients with hip fractures undergoing surgeries suffer from massive blood loss.The hidden blood loss accounts for a large proportion of the total blood loss.Clinicians should pay attention to the evaluation of perioperative blood loss,especially the evaluation of hidden blood loss.The meta-analysis indicates that intravenous route of tranexamic acid shows an ability to reduce transfusion requirements and total blood loss,not increasing the incidence of thromboembolic events in patients undergoing hip surgeries.