Efficacy and safety of tranexamic acid in elderly patients with intertrochanteric fracture: An updated meta-analysis

Table 1 Characteristic of included studies in meta-analysis

Study and year	Country	Design	TXA group	Control group	DVT PPX	Sample size (cases/ contros)	No. of females (cases/ controls, %)	Surgical proce-dure	Anesthesia method	Draina-ge	Transfusion trigger	Follow-up	QAS
Mohib_2015	Pakistan	DB-RCT	15 mg/kg, IV, twice	Normal saline	Enoxapa-rin	50/50	58/52	Not mention-ed	Not mention-ed	Not mention-ed	< 7g/dL	Dischar-ge	21
Baruah_2016	India	RCT	15 mg/kg, IV	Normal saline	Not mention-ed	30/30	20/16.7	DHS	Spinal anaesthe-sia	Yes	< 8.5 g/dL	Dischar-ge	19
Drakos_2016	Creece	DB-RCT	3 g, local administration, at the end of surgery	None	LMWH	100/100	73/79	Short Cephalomedulla-ry Nail (GAMMA3)	Spinal anaesthe-sia	None	< 8 g/dL	12 mo	21
Tengber-g_2016	Denmark	DB-RCT	1 g, IV, pre-operation; 3 g, IV, post-operation	Placebo	LMWH	33/39	78.7/64.1	Short Intramedullary Nail (IMH)	Epidural analge-sia	Not mention-ed	< 9.96 g/dL	4 mo	24
Virani_2016	India	RCT	2 g, intramucsular and subfascial infiltra-tion	None	Not mention-ed	67/70	62/61	DHS	Spinal anaesthe-sia	Yes	Not mention-ed	Dischar-ge	20
Lei_2017	China	RCT	1 g, IV, pre-operation	Normal saline	Not mention-ed	37/40	82.1/80.4	PFNA	Not mention-ed	Yes	< 9 g/dL	1 mo	20
Tian_2018	China	RCT	10 mg/kg IV, pre-operation and post-operation	None	LMWH	50/50	62/72	Intramedullary nail	Not mention-ed	Yes	< 9 g/dL	4 mo	21
Schiavo-ne_2018	Italy	RCT	15 mg/kg, IV, start with surgery	Saline	Not mention-ed	47/43	35/28	Gamma nail	Loco-regional anesthe-sia, or general anesthe-sia	Not mention-ed	< 8.5 g/dL	3 mo	20

DB: Double blind; RCT: Randomized controlled trial; IV: Intravenous administration; DHS: Dynamic hip screw; LMWH: Low molecular weight heparin; QAS: Quality assessment score; PFNA: Proximal femoral nail antirotation.

Table 2 Tranexamic acid for intertrochanteric fracture

Outcomes	Illustrative comparative risks1 (95%CI)		Relative effect (95%CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	TXA
Intraoperative blood loss. Measurement. Scale: 0 to 5; follow-up: 0.25 to 12 mo.	See comments	See comments		309 (4 studies)	++++ high
Postoperative blood loss Drainage. Scale: 0 to 4; follow-up: 0.25 to 12 mo.	See comments	See comments		214 (3 studies)	++++ high
Hidden blood loss. Calculation. Scale: 0 to 4; follow-up: 0.25 to 12 mo.	See comments	See comments		177 (2 studies)	++++ high
Total blood loss. Measurement. Scale: 0 to 5; follow-up: 0.25 to 12 mo.	See comments	See comments		309 (4 studies)	++++ high
DVT. Imageological examination; follow-up: 0.25 to 12 mo.	Study population		OR = 1.34 (0.49 to 3.69)	539 (5 studies)	++++ high
	22 per 1000	29 per 1000 (11 to 77)
	Moderate
No. of transfusion. Follow-up; follow-up: 0.25 to 12 mo.	Study population		OR = 0.50 (0.36 to 0.69)	836 (8 studies)	++++ high
	505 per 1000	338 per 1000 (268 to 413)
	Moderate

¹The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95%CI). Patient or population: Patients with intertrochanteric fracture; Settings: Inpatients; Intervention: Tranexamic acid Grading of Recommendations Assessment, Development and Evaluation. Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. TXA: Tranexamic acid.