Safety and efficacy of tranexamic acid in pelvi-acetabular trauma surgery: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Pelvic and acetabular fractures, often resulting from high-impact trauma, pose significant challenges due to extensive blood loss and complex surgical procedures. Tranexamic acid (TXA), widely used in elective orthopedic surgeries, offers a potential strategy for managing blood loss. However, its efficacy and safety in pelvic-acetabular trauma surgeries have shown inconsistent results in prior studies.

OBJECTIVE

To systematically evaluate the safety and efficacy of intravenous TXA in reducing perioperative blood loss, transfusion requirements, and complications in pelvic and acetabular trauma surgeries.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Literature searches of PubMed, Embase, and Cochrane databases identified relevant studies. Data on blood loss, transfusion rates, thromboembolic events, surgical time, and complications were extracted and analyzed using RevMan 5.4 software. A random-effects model was applied to account for heterogeneity.

RESULTS

After screening, a total of 6 RCTs with 511 patients were included in this meta-analysis. TXA did not significantly reduce estimated blood loss (mean difference: 117.54 ml; 95% CI - 286.48-51.40; p = 0.17) or transfusion rates (risk ratio: 0.88; 95% CI 0.48-1.60; p = 0.67). No significant differences were observed in the number of transfused blood units, surgical duration, or complication rates, including thromboembolic events (risk ratio: 1.36; 95% CI 0.57-3.22; p = 0.48). TXA demonstrated a favorable safety profile with no increased risk of systemic or local complications.

CONCLUSION

While TXA appears safe in pelvi-acetabular trauma surgery, current evidence from six RCTs does not support a significant reduction in blood loss or transfusion needs. Further high-quality RCTs with standardized protocols are needed to refine TXA's role in this context.