The efficacy and safety of tranexamic acid in foot and ankle surgery: A systematic review and meta-analysis of comparative clinical studies

Abstract

BackgroundA comprehensive review of the current evidence investigating the potential therapeutic effects of tranexamic acid (TXA) and its safety in foot and ankle surgery is provided in this research study. MethodsWe followed the PRISMA guidelines to conduct a systematic review on TXA administration in foot and ankle surgeries. MEDLINE/PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library were searched comprehensively from inception to June 2022, as well as hand searching to include level I and III studies. A total of 970 records were reviewed, and seven comparative studies with a total of 514 patients were included in two groups: intervention (n = 257) and control (n = 257). Two studies used local TXA, and five studies used intravenous TXA. Three studies included calcaneal fractures, three included total ankle arthroplasty (TAA), and one had all ambulatory foot and ankle surgeries. Outcome variables were postoperative blood loss, hemoglobin change, and postoperative complications. ResultsPooled mean difference (MD) of postoperative blood loss after 24 h was − 142.08 ml (95% CI, −177.92 to −106.24; P < 0.001; I2= 14%) showing a significant decrease in blood loss due to TXA use in both TAA and calcaneal fracture. Also hemoglobin drop was significantly lower in TXA group with a pooled MD of 0.56 g/dL (95% CI, 0.34–0.77; P < 0.001; I2= 73%). The odds ratio of wound complication after using TXA was 0.71 (95% CI, 0.42–1.21; P = 0.21; I2= 9.4%), revealing no significant correlation between TXA use and wound complications. Moreover our meta-analysis revealed no correlation between TXA use and thromboembolic events [OR = 0.67; P = 0.71; I2= 0% ). ConclusionsThe use of TXA has been demonstrated to reduce blood loss during foot and ankle surgery in an effective and safe manner. The optimum time of administration, optimum dosage, and the administration way (local vs. IV) should be researched in future studies. Level of evidenceIII