Update on the efficacy and safety of intravenous tranexamic acid in hip fracture surgery: a systematic review and meta-analysis.

AIM: The aim of this meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA) in the management of hip fracture surgeries in comparison with placebo. METHODS: A systematic search was conducted from August 6, 2021. Eligible studies included randomized clinical trials and prospective studies comparing the use of intravenous TXA in patients treated for hip fractures, in comparison with placebo. Review Manager was used for the meta-analysis. RESULTS: Eighteen prospective studies including 14 RCTs met the eligibility criteria. The results favored the TXA group in the quantity of total blood loss (MD = - 196.91 mL, 95% CI - 247.59, - 146.23, I2 = 92%), intraoperative blood loss (MD = - 26.86 mL, 95% CI - 36.96, - 16.78, I2 = 62%), and rate of blood transfusion (OR 0.35, 95% CI 0.28, 0.42, I2 = 0%). TXA also exhibited higher hemoglobin level at day 1 (MD = 6.77 g/L, 95% CI 4.30, 9.24, I2 = 83%) and day 3 (MD = 7.02 g/L, 95% CI 3.30, 10.74, I2 = 82%) postoperatively. There was no significant difference found in the incidence of thromboembolic events from occurring between the two groups, such as deep vein thrombosis (OR 1.22, 95% CI 0.73, 2.02, I2 = 0%) and pulmonary embolism (OR 0.82, 95% CI 0.33, 2.05, I2 = 0%). CONCLUSION: Administration of intravenous TXA appears to reduce blood loss, rate of blood transfusions and pose no increased risk of thromboembolic events. Therefore, TXA should be considered by physicians when managing hip fracture patients.

Open versus laparoscopic surgery in the management of patients with gallbladder cancer: A systematic review and meta-analysis.

BACKGROUND: The aim of this meta-analysis was to assess the safety and efficacy of laparoscopic surgery when compared to open surgery in the management of gallbladder cancer. METHODS: Ovid Cochrane Library, Medline, Embase, Epub, and Scopus were searched. A meta-analysis of selected studies was performed, and a subgroup analysis was performed by tumor stage. RESULTS: Fourteen studies met the eligibility criteria with a total of 1792 participants undergoing either laparoscopic or open surgery. Survival rate of laparoscopic group was higher than open group at T2 tumor stage after 1 year (OR = 2.130, 95%CI: 1.372, 3.306, I2 = 0%) and 2 year (OR = 2.074, 95%CI: 1.411, 3.050, I2 = 0%) as well as T3 tumor stage after 1 year (OR = 2.805, 95%CI: 1.631, 4.826, I2 = 0%) and 2 year (OR = 2.453, 95%CI: 1.367, 4.400, I2 = 0%). Additionally, overall recurrence rate between laparoscopic and open cohorts was similar (OR: 1.098, 95%CI: 0.774, 1.558, I2 = 5.56%). CONCLUSION: In comparison to open surgery, the results seem to show a trend favoring laparoscopic surgery as a possible alternative treatment option to commence the management of gallbladder cancer.