Journal of orthopaedic surgery and research · 2026
Safety and clinical efficacy of topical TXA in orthopedic trauma surgery: a systematic review and meta analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Alenezi Mohammed, Aljudai Meshal Abdulaziz, Alahmari Mohammed Ali, Haiz Esraa Taleb Al, Alowa Fatimah Taher, Alasmari Ziyad Saad, Alrasheedi Ghada Musaed, Alsaif Bader Mohammed, Alotaibi Ghazi Moahmmed, Alqahtani Meshal Ahmed M, Bin Khalid Arnous Saif, Qutub Ammar Fareed
Аннотация
BACKGROUND: Perioperative blood loss remains a major challenge in orthopedic trauma surgery, often necessitating transfusions and associated risks. Tranexamic acid (TXA), an antifibrinolytic agent, is increasingly used to minimize bleeding, yet the role of topical TXA in trauma surgery is less clearly defined.
METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Randomized controlled trials comparing topical tranexamic acid (TXA) with placebo or comparators in orthopedic trauma surgery were identified through searches of PubMed, MEDLINE, EMBASE, CENTRAL, WHO ICTRP, and ISRCTN up to April 5, 2025. Two.reviewers independently screened, extracted data, and assessed quality using ROB2 and ROBINS-I tools. Outcomes included total blood loss, intra operative blood loss, post operative blood loss, hidden blood loss, transfusion rates, complications, overall mortality, and operation time. Data were pooled in RevMan 5.4 using random-effects models, with heterogeneity assessed by χ2 and I2. Sensitivity analyses and funnel plots were performed to evaluate robustness and publication bias.
RESULTS: Fourteen studies involving 1497 patients were included in the analysis. Topical TXA reduced postoperative blood loss ( p < 0.00001) and total blood loss ( p < 0.00001). Transfusion requirements were consistently lower in the TXA groups ( p = 0.004 ). No significant reduction in hidden blood loss ( p = 0.06) intra operative blood loss ( p = 0.09 ) and hospital stay ( p = 0.07 ) was observed compared to placebo or standard care. No significant increase in operation time ( p = 0.10 ), complications ( p = 0.75 ), or short-term mortality was observed ( p = 0.07 ) .
CONCLUSION: Topical TXA is a safe and effective method for reducing perioperative blood loss and transfusion needs in orthopedic trauma surgery. While current evidence supports its routine use, further large-scale, multicenter trials with standardized dosing protocols are warranted to confirm longterm safety and establish optimal administration regimens.
METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Randomized controlled trials comparing topical tranexamic acid (TXA) with placebo or comparators in orthopedic trauma surgery were identified through searches of PubMed, MEDLINE, EMBASE, CENTRAL, WHO ICTRP, and ISRCTN up to April 5, 2025. Two.reviewers independently screened, extracted data, and assessed quality using ROB2 and ROBINS-I tools. Outcomes included total blood loss, intra operative blood loss, post operative blood loss, hidden blood loss, transfusion rates, complications, overall mortality, and operation time. Data were pooled in RevMan 5.4 using random-effects models, with heterogeneity assessed by χ2 and I2. Sensitivity analyses and funnel plots were performed to evaluate robustness and publication bias.
RESULTS: Fourteen studies involving 1497 patients were included in the analysis. Topical TXA reduced postoperative blood loss ( p < 0.00001) and total blood loss ( p < 0.00001). Transfusion requirements were consistently lower in the TXA groups ( p = 0.004 ). No significant reduction in hidden blood loss ( p = 0.06) intra operative blood loss ( p = 0.09 ) and hospital stay ( p = 0.07 ) was observed compared to placebo or standard care. No significant increase in operation time ( p = 0.10 ), complications ( p = 0.75 ), or short-term mortality was observed ( p = 0.07 ) .
CONCLUSION: Topical TXA is a safe and effective method for reducing perioperative blood loss and transfusion needs in orthopedic trauma surgery. While current evidence supports its routine use, further large-scale, multicenter trials with standardized dosing protocols are warranted to confirm longterm safety and establish optimal administration regimens.