Effet sur la perte sanguine de l’utilisation de l’acide tranexamique chez des patients gériatriques traités par enclouage fémoral centromédullaire proximal : revue systématique et méta-analyse

Abstract Background Recently, there has been a series of clinical studies focusing on the perioperative administration of tranexamic acid (TXA) in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery. However, the safety and efficacy of TXA in these patients remains controversial. Therefore, we performed a systematic review to focus on two questions: (1) would TXA reduce perioperative blood loss in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery? and (2) would TXA increase the rate of perioperative complications in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery? Patients and methods We systematically searched electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials) up to April 20, 2019. The perioperative blood loss and complication data were extracted and analysed by RevMan Manager 5.3. Results Finally, five randomized controlled studies, involving 539 geriatric intertrochanteric fracture patients undergoing proximal femoral intramedullary nail surgery, were enrolled in this systematic review. Compared with the control group, the TXA group had significantly lower total perioperative blood loss (WMD = − 172.84; 95% CI, − 241.44 to − 104.24; I2 = 0%), intraoperative blood loss (WMD = − 34.20; 95% CI, − 46.04 to − 22.36; I2 = 0%), total perioperative hidden blood loss (WMD = − 139.05; 95% CI, − 213.67 to − 64.43; I2 = 0%), perioperative transfusion rates (RR = − 0.16; 95% CI, − 0.24 to − 0.08; I2 = 22%), length of hospital stay (WMD = − 1.18; 95% CI, − 1.91 to − 0.46; p = 0.001; I2 = 12%), and postoperative wound haematoma rates (RD = − 0.05; 95% CI, − 0.09 to 0.00; p = 0.03; I2 = 0%). In addition, there were no significant differences between TXA and control groups in the terms of surgical time, postoperative mortality, total thromboembolic events, wound infections, cerebrovascular accidents, respiratory infections, and renal failure. Discussion TXA in geriatric trauma patients undergoing intramedullary nail surgery is effective for perioperative haemostasis without increasing the incidence of postoperative complications. Level of evidence II, Systematic review and meta-analysis.