Table 1.
The characteristics of studies regarding IV TXA
| Study ID | No I vs C | Mean age (years): I vs C | Anesthesia | Fracture type | Surgical management | Intervention | Control | Thromboprophylaxis | Transfusion criteria | Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|
| Sadeghi and Mehr-Aein (2007)18 | 32/35 | 51.8/44.4 | Spinal anesthesia | Intracapsular, extracapsular fractures | Hemiarthroplasty, plating, nailing | 15 mg/kg before surgery | Normal saline | NR | NR | NR |
| Zufferey et al (2010)19 | 57/53 | 81/82 | General anesthesia | Cervical only, trochanteric, transtrochanteric fractures | Total hip arthroplasty, hemiarthroplasty, dynamic hip screw, intramedullary nail | 15 mg/kg before surgery, a second 15 mg/kg 3 h later | Placebo | Fondaparinux | Hb <9 g/dL | 1 year |
| Vijay et al (2013)20 | 45/45 | 48.8/49.3 | Combined spinal epidural anesthesia | Hip and femoral fractures | Open reduction internal fixation, hemiarthroplasty, total hip replacement | A bolus of 500 mg TXA through 50 mL syringe during 10 min, ~15 min before incision and a continuous infusion of 1 mg/kg/h dissolved in 1 L of saline until the end of surgery | Normal saline | NR | A reduction in hemoglobin exceeding 25% of preoperative level | NR |
| Emara et al (2014)21 | 20/20 | 56.5/56 | General anesthesia | Hip fracture | Hemiarthroplasty | 20 mg/kg in 20 mL normal saline before skin incision, 500 mg TXA in 250 mL normal saline with rate of 80 mL/h until the end of surgery | Normal saline | Low-molecular-weight heparin | NR | 4 weeks |
| Mohib et al (2015)23 | 50/50 | 69.0/70 | NR | Intertrochanteric fracture | NR | 10 mg/kg before surgery, a second 10 mg/kg 3 h later | Placebo | Enoxaparin | Hb <7 g/dL | NR |
| Tengberg et al (2016)26 | 33/39 | 79.8/75.0 | Epidural anesthesia | Trochanteric fracture | Intramedullary nail | 1 g just prior to surgery, 3 g postoperatively | Placebo | Low-molecular-weight heparin | Hb <9.67 g/dL | 90 days |
| Haghighi et al (2017)28 | 18/20 | 65.1/66.1 | General anesthesia | Femoral fracture | Intramedullary nail | 15 mg/kg before incision | Normal saline | NR | NR | NR |
| Baruah et al (2016)24 | 30/30 | 57.7/55.3 | Spinal anesthesia | Trochanteric fracture | Dynamic hip screw plate fixation | A single dose of TXA (15 mg/kg) 15 min prior to surgery | Normal saline | NR | Hb <8.5 g/dL Hematocrit level <27% | NR |
| Watts et al (2017)30 | 69/69 | 81.0/82.2 | General anesthesia | Femoral neck fracture | Hemi or total hip arthroplasty | 2 doses of 15 mg/kg, 1 dose just before incision and the second dose at wound closure | Normal saline | Low-molecular-weight heparin | Hb <8.0 g/dL | 6 months |
| Lei et al (2017)29 | 37/40 | 77.8/79.2 | NR | Intertrochanteric fracture | Proximal femoral nail antirotation | 1 g after anesthesia, but before surgery | Normal saline | NR | Hb <9 g/dL | 30 days |
| Lee et al (2015)22,* | 84/187 | 86/85 | General anesthesia ± block, spinal anesthesia | Hip fracture | Hemiarthroplasty | A bolus of 1 g TXA intravenously on induction | NR | Tinzaparin | NR | NR |
Note: All studies were RCTs except Lee et al (2015),22 which was an observational cohort study.
*
Observational cohort study.
Abbreviations: IV, intravenous; TXA, tranexamic acid; I, intravenous TXA group; C, control group; NR, no report; RCT, randomized controlled trial.