SLR - November 2023 - Perry
Title: The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: a meta-analysis and systematic review of randomized controlled trialsReference: Tang, X., Li, K., Zheng, F., He, Y., Yang, Y., & Wang, D. (2023, July 12). The effect of perioperative tranexamic acid (TXA) in patients with calcaneal fractures: A meta-analysis and systematic review of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 18(1), 1-11. https://doi.org/10.1186/s13018-023-03924-0
Level of Evidence: II
Reviewed by: Donovan Perry
Residency Program: HCA Florida Northwest Hospital
Podiatric Relevance: Calcaneal fractures can be life changing fractures that can expose our patients to multiple long-term complications. These high energy fractures present a unique challenge secondary to the anatomy of the calcaneus and its surrounding structures. Therefore, the optimization of our patients for favorable surgical outcomes is of paramount importance.
This study examined four randomized controlled studies that evaluated the blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication in patients that were given tranexamic acid (TXA) preoperatively to their surgical intervention for their calcaneal fracture.
Methods: This level II study reviewed electronic records on February 2023 of four randomized control trials who met their inclusion criteria of intra-articular calcaneal fractures who underwent open reduction with internal fixation (ORIF) and were given either TXA or a placebo preoperatively.
Results: A total of 4 trials with 255 participants were evaluated. This study found that TXA administration reduced postoperative blood loss within 24h, however there was no difference in the intraoperative blood loss. The rate of wound complications were also lower in the TXA group as compared to the control. Additionally, the TXA group possessed higher levels of hemoglobin and hematocrit with no difference in the platelet count, aPTT, or PT of the control group.
Conclusion: TXA can significantly reduce blood loss during the first 24 h postoperatively, improve the levels of hemoglobin and hematocrit, and reduce the risk of wound complications. Wound complications following surgical intervention can be devastating and often begin an extensive sequela of local wound care and infection management. Optimizing our patients with TXA perioperatively, can significantly reduce postoperative complications that can be physically and financially costly.