Efficacy and Safety of Topical Tranexamic Acid in Elderly Hip Fractures Undergoing Surgical Treatment: Meta-Analysis of Randomized Controlled Trials.

Background: Hip fractures are a major health concern, especially among older adults. The conventional treatment for this condition involves surgery, but it carries the risk of excessive blood loss and complications. Tranexamic acid (TXA) has emerged as a possible solution for reducing bleeding during surgery. This study aims to evaluate the safety and efficacy of topical TXA compared to systemic TXA and a placebo in adult patients undergoing surgical treatment for hip fractures. Methods: The literature was reviewed using 3 databases (PubMed, Scopus, and Google Scholar) for studies published up to November 2023. All randomized controlled trials (RCTs) assessing the effectiveness of topical TXA in hip fracture surgery were included for analysis. Two reviewers assessed the quality of studies independently using the Cochrane-recommended risk-of-bias tool. Statistical analysis was performed on Comprehensive Meta-Analysis Software (version 2.0). Results: Nine RCTs with 1,024 patients assessed topical TXA in hip fracture surgery. Topical TXA significantly reduced hemoglobin loss (mean difference [MD], 1.004 g/dL; 95% CI, 0.096-1.911; Conclusions: The available evidence suggests that local TXA can significantly reduce hemoglobin loss and the number of transfused blood units without the risk of DVT compared to a placebo. Furthermore, local TXA demonstrated comparable effectiveness and safety to intravenous TXA following hip fracture surgery. Subgroup analysis revealed that topical TXA significantly decreased the hemoglobin drop and total blood loss in the arthroplasty group, as compared to the placebo.