Safety and clinical efficacy of topical TXA in orthopedic trauma surgery: a systematic review and meta analysis

BACKGROUND: Perioperative blood loss remains a major challenge in orthopedic trauma surgery, often necessitating transfusions and associated risks. Tranexamic acid (TXA), an antifibrinolytic agent, is increasingly used to minimize bleeding, yet the role of topical TXA in trauma surgery is less clearly defined. METHODS: . Sensitivity analyses and funnel plots were performed to evaluate robustness and publication bias. RESULTS: Fourteen studies involving 1497 patients were included in the analysis. Topical TXA reduced postoperative blood loss ( p < 0.00001) and total blood loss ( p < 0.00001). Transfusion requirements were consistently lower in the TXA groups ( p = 0.004 ). No significant reduction in hidden blood loss ( p = 0.06) intra operative blood loss ( p = 0.09 ) and hospital stay ( p = 0.07 ) was observed compared to placebo or standard care. No significant increase in operation time ( p = 0.10 ), complications ( p = 0.75 ), or short-term mortality was observed ( p = 0.07 ) . CONCLUSION: Topical TXA is a safe and effective method for reducing perioperative blood loss and transfusion needs in orthopedic trauma surgery. While current evidence supports its routine use, further large-scale, multicenter trials with standardized dosing protocols are warranted to confirm longterm safety and establish optimal administration regimens.