Tranexamic Acid on Admission to Hospital in Hip Fracture Patients: A Scoping Review of Early Use for Reducing Blood Loss and Transfusion Risk

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The final conclusion is not valable regarding the controversal data in the cited studies

Author Response

Comment 1: The final conclusion is not valable regarding the controversial data in the cited studies

Response: We would like to thank the reviewer for their comments and feedback. We have not made any firm conclusions in the abstract or the manuscript and simply suggest that current literature supports the use of TXA in those patients with a hip fracture, and more specifically those with an extracapsular fracture.

Abstract:

Early TXA administration in hip fracture patients appears to be safe and may reduce transfusion requirements. Further high-quality research is warranted to determine the optimal timing and dosing strategy for TXA in this setting and to confirm its efficacy in reducing perioperative blood loss and transfusion risk.

Manuscript:

This scoping review supports the safety of early TXA administration in patients presenting with a hip fracture, and more specifically, those sustaining an extracapsular fracture. Overall, while evidence is mixed, there is a favourable trend supporting the use of TXA on admission to reduce transfusion needs without increasing adverse events. Further high-quality RCTs focusing specifically on early TXA administration are needed to strengthen the evidence base.

Reviewer 2 Report

Comments and Suggestions for Authors

I have no particular comments. The topic is still under debate and the authors give a review of the state of the art of tranexamic acid admistration in patients with hip fracture.  The largest advantage in patients with major trauma has been reported with early drug admnistration. The authors should underline this aspect  since in  most of the cited studies tranexamic acid was administered at hospital adimission and there are no data of the time lasted from trauma and hospitazion 

Author Response

Comments: I have no particular comments. The topic is still under debate and the authors give a review of the state of the art of tranexamic acid admistration in patients with hip fracture.  The largest advantage in patients with major trauma has been reported with early drug admnistration. The authors should underline this aspect  since in  most of the cited studies tranexamic acid was administered at hospital adimission and there are no data of the time lasted from trauma and hospitazion 

Response: We would like to thank the reviewer for highlighting this major limitation. We have not included this in the limitations section of the review:

One of the major limitations of the studies reporting the use of TXA in hip fracture patients is the reporting of time from injury to administration of TXA, with the majority simply administering this on admission to the hospital. The CRASH-2 trial established that administration of TXA after 3 hours from injury, in all trauma patients, was unlikely to be effective [7]. Whether this applies to hip fracture patients is not clear, and further work is required to establish the optimal time window for administration.

Reviewer 3 Report

Comments and Suggestions for Authors

This scoping review supports the safety of early TXA administration in patients presenting with a hip fracture, and more specifically, those sustaining an extracapsular fracture. Overall, while evidence is mixed, a favorable trend supports the use of TXA on admission to reduce transfusion needs without increasing adverse events. Further high-quality RCTs focusing specifically on early TXA administration are needed to strengthen the evidence base. The evidence supports the early TXA administration if a delay in the surgical procedure is foreseen.

Author Response

Comments: This scoping review supports the safety of early TXA administration in patients presenting with a hip fracture, and more specifically, those sustaining an extracapsular fracture. Overall, while evidence is mixed, a favorable trend supports the use of TXA on admission to reduce transfusion needs without increasing adverse events. Further high-quality RCTs focusing specifically on early TXA administration are needed to strengthen the evidence base. The evidence supports the early TXA administration if a delay in the surgical procedure is foreseen.

Response: We really appreciate this positive review, and we fully agree with the reviewer. Although the evidence is not strong, there is a definite trend in a better outcome with no obvious drawbacks.