Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-analysis

Authors

  • Nicholas Dombrowski, B.S. University of Kansas School of Medicine
  • Jake Enos, M.D. The University of Kansas Health System
  • Erik Henkelman, M.D. The University of Kansas Health System
  • Damon Mar, Ph.D. The University of Kansas Health System
  • Armin Tarahemeh, B.S. The University of Kansas Health System
  • Bryan Vopat, M.D. The University of Kansas Health System

DOI:

https://doi.org/10.17161/kjm.vol16.21262

Keywords:

Tranexamic acid, Foot and ankle, Blood loss, Wound, Surgery

Abstract

Introduction. Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy.

Methods.This systematic review utilized PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through December 22, 2022. Key words used in the search included: “tranexamic acid,” “TXA,” “foot,” “ankle,” “calcaneal,” and “surgery.” The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour post-operative blood loss, blood loss from hour 24 to hour 48, post-operative hemoglobin (Hgb), and post-operative hematocrit [Hct]), as well as wound complications and vascular events. Meta-regression was included to assess the impact of age on between-study variation.

Results. Ten studies met preliminary inclusion criteria. Upon further inspection, eight met full inclusion criteria for the meta-analysis. Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour post-operative blood loss (MD=-183.41 mL, 95% CI=-247.49 to -119.34 mL, p<0.001), increased post-operative hemoglobin (MD=0.71 g/dL, 95% CI=0.11 to 1.31 g/dL, p=0.020) and hematocrit (MD=2.66%, 95% CI=0.07 to 5.24%, p=0.040) when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications. Meta-regression indicated no clinically relevant association of age to between-study variation.

Conclusions. TXA was found to be a safe treatment that did affect wound healing or infection rates while decreasing perioperative blood loss. Further research should be performed to evaluate the long-term effects of TXA administration on patient outcomes after foot and ankle surgery.

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Published

2023-11-30

How to Cite

Dombrowski, N., Enos, J., Henkelman, E. ., Mar, D., Tarakemeh, A., & Vopat, B. (2023). Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-analysis. Kansas Journal of Medicine, 16(3), 302–308. https://doi.org/10.17161/kjm.vol16.21262