Poster 357: Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-analysis

Objectives: 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 aim 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 was a systematic review following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as outlined on the PRISMA checklist. Databases utilized included PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through May 21, 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 postoperative blood loss, blood loss from hour 24 to hour 48, postoperative hemoglobin (Hgb), and postoperative hematocrit (Hct)), as well as wound complications and vascular events. Wound complications and vascular events were defined as infection, hematoma formation, necrosis, dehiscence, DVT, PE, myocardial infarction (MI), acute coronary syndrome (ACS), cardiovascular event (CVA), limb ischemia (LI), gastrointestinal hemorrhage (GIH), nerve damage, and any other conditions specified as wound complications or vascular events within individual studies. The Cochrane Collaboration’s Risk of Bias 2 (RoB2) tool was used to assess the risk of bias in the studies included. The quality of the studies included was scored using a modified Coleman methodology score (MCMS). Primary treatment outcomes having data from three or more studies available were summarized in forest plots using RevMan 5.4.1 software (The Cochrane Collaboration, Copenhagen, Denmark). Random-Effects models were used to calculate mean differences with 95% confidence intervals for each outcome measure. Heterogeneity of studies was assessed using Tau2, Chi2, and I2 statistics. Statistical significance was set at α=0.05 for all comparisons. Results: The literature search produced 1125 papers. The full texts of 16 studies were assessed using inclusion and exclusion criteria and seven studies met preliminary inclusion criteria. Upon further inspection, five met full inclusion criteria for the meta-analysis. All groups receiving TXA