A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis

OBJECTIVESpondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes.METHODSA meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw–based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2.RESULTSForty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle screw groups were 13.41%, 22.35%, 27.42%, and 12.8%, respectively, and the pooled positive outcome rates for the Buck, Scott, Morscher, and pedicle screw groups were 84.33%, 82.49%, 80.30%, and 80.1%, respectively. The pedicle group had the best fusion rate and lowest complication rate.CONCLUSIONSThe pedicle screw–based direct pars repair for spondylolysis and low-grade spondylolisthesis is the best choice of procedure, with the highest fusion and lowest complication rates, followed by the Buck repair. The Morscher and Scott repairs were associated with a high rate of complication and lower rates of fusion.

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The comparative accuracy and safety of fluoroscopic and navigation-based techniques in cervical pedicle screw fixation: systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201877 ◽

2021 ◽

pp. 1-8

Author(s):

Ahmad M. Tarawneh ◽

Shahnawaz Haleem ◽

Daniel D’Aquino ◽

Nasir Quraishi

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Meta Analysis ◽

Pedicle Screw Fixation ◽

Cochrane Library ◽

Complication Rates ◽

Ct Guided ◽

Cervical Pedicle Screw ◽

Comparative Accuracy ◽

Cervical Pedicle

OBJECTIVE The goal of this study was to evaluate the comparative accuracy and safety of navigation-based approaches for cervical pedicle screw (CPS) placement over fluoroscopic techniques. METHODS A systematic search of the literature published between January 2006 and December 2019 relating to CPS instrumentation and the comparative accuracy and safety of fluoroscopic and intraoperative computer-based navigation techniques was conducted. Several databases, including the Cochrane Library, PubMed, and EMBASE, were systematically searched to identify potentially eligible studies. Data relating to CPS insertion accuracy and associated complications, in particular neurovascular complications, were extrapolated from the included studies and summarized for analysis. RESULTS A total of 17 studies were identified from the search methodology. Eleven studies evaluated CPS placement under traditional fluoroscopic guidance and 6 studies addressed outcomes following navigation-assisted placement (3D C-arm or CT-guided placement). Overall, a total of 4278 screws were placed in 1065 patients. Misplacement rates of CPS were significantly lower (p < 0.0001) in navigation-assisted techniques (12.51% [range 2.5%–20.5%]) compared to fluoroscopy-guided techniques (18.8% [range 0%–43.5%]). Fluoroscopy-guided CPS insertion was associated with a significantly higher incidence of postoperative complications relating to neurovascular injuries (p < 0.038), with a mean incidence of 1.9% compared with 0.3% in navigation-assisted techniques. CONCLUSIONS This systematic review supports a logical conclusion that navigation-based techniques confer a statistically significantly more accurate screw placement and resultant lower complication rates.

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Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10122636 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2636

Author(s):

Ka Wing Ma ◽

Hoonsub So ◽

Euisoo Shin ◽

Janice Hoi Man Mok ◽

Kim Ho Kam Yuen ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pain Relief ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Endoscopic Drainage ◽

Complication Rates ◽

Surgical Drainage ◽

Endocrine Insufficiency ◽

Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

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Effect of Statins on the Risk of Different Stages of Prostate Cancer: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000518164 ◽

2021 ◽

pp. 1-9

Author(s):

Yun Li ◽

Xuan Cheng ◽

Jia-lian Zhu ◽

Wen-wen Luo ◽

Huai-rong Xiang ◽

...

Keyword(s):

Prostate Cancer ◽

Lower Risk ◽

Advanced Prostate Cancer ◽

Meta Analysis ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

The Cochrane Library ◽

The Relationship ◽

Comprehensive Literature Search

Introduction: The aim of this article was to investigate the relationship between statins and the risk of different stages or grades of prostate cancer. Methods: A comprehensive literature search was performed for articles published until December 18, 2020, on the PubMed, Embase, and the Cochrane Library databases. The pooled relative risk (RR) and 95% confidence interval (CI) were then analyzed using the STATA.16.0 software. Results: A total of 588,055 patients from 14 studies were included in the analysis. We found that the use of statins expressed a significant correlation with a lower risk of advanced prostate cancer (RR = 0.81, 95% CI: 0.73–0.91; RR = 0.86, 95% CI: 0.75–0.99, respectively). However, no evidence suggested that the use of statins was beneficial for the prevention of localized prostate cancer incidence. Similarly, the pooled results also revealed no association between the use of statins and the risk of high-grade and low-grade prostate cancer. Conclusion: It has been found that the use of statins is associated with a lower risk of advanced prostate cancer but was not related to the risk of localized, low-grade, or high-grade prostate cancer.

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Abstract 14948: Comparative Effectiveness of CRT in Older Patients With Heart Failure: Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.14948 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Saeed Juggan ◽

Clifford A Reilly ◽

Praveen K Ponnamreddy ◽

Lauren Gilstrap ◽

Emily Zeitler

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Comparative Effectiveness ◽

Older Patients ◽

Meta Analysis ◽

Cardiac Resynchronization ◽

Cochrane Library ◽

Complication Rates ◽

Younger Patients ◽

Risk Of Death

Background: The pivotal cardiac resynchronization therapy (CRT) trials enrolled patients significantly younger than the typical contemporary heart failure with reduced ejection fraction (HFrEF) patients. Benefits of CRT in older HFrEF patients is largely unknown and may be less due to higher comorbidity burdens and higher procedural risk. We sought to address this evidentiary gap through meta-analysis. Hypothesis: Compared to patients <70 years old (”younger”), patients ≥ 70 years old (“older”) have similar mortality rates, rates of complications and changes in ejection fraction (EF) following CRT. Methods: PubMed, The Cochrane Library, Scopus, and Web of Science were queried for comparative effectiveness studies of CRT in older HFrEF patients. Differences in mortality and mean difference (MD) in EF were calculated between groups. Random effects meta-analysis of MD in EF (older minus younger) and relative risk (RR) of death and complications are reported along with estimates of heterogeneity. Results: Seven studies [n= 4381 younger, 1203 older] were included in LVEF meta-analysis. Compared to younger patients, there was greater EF improvement in older patients [MD 1.20; 95% CI 0.13 - 2.28, p=0.03, I 2 =46%]. RR of mortality was analyzed for 11 studies [n=5038 younger, 1653 older] (Figure). Survival was better in younger patients [RR 1.06; 95% CI 1.04 - 1.09, p<0.01, I 2 =0%]. No significant differences in complication rates were observed between younger and older patients. Conclusions: CRT in older patients was associated with greater improvement in EF than younger patients. Mortality is greater in older patients which may reflect greater underlying risk of death from competing causes. Figures:

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A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa050 ◽

2020 ◽

Vol 58 (1) ◽

pp. 40-50 ◽

Cited By ~ 1

Author(s):

Masahiro Yanagiya ◽

Takuya Kawahara ◽

Keiko Ueda ◽

Daisuke Yoshida ◽

Hirokazu Yamaguchi ◽

...

Keyword(s):

Meta Analysis ◽

Pulmonary Nodules ◽

Pulmonary Haemorrhage ◽

Cochrane Library ◽

Complication Rates ◽

Resection Rate ◽

Electromagnetic Navigation ◽

Meta Analyses ◽

Dye Marking ◽

Pleural Injury

Abstract OBJECTIVES Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking. METHODS The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking. RESULTS Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively. CONCLUSIONS This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.

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Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

Journal of Ophthalmology ◽

10.1155/2020/4310258 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Xuhao Chen ◽

Lingge Suo ◽

Ying Hong ◽

Chun Zhang

Keyword(s):

Success Rate ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Subconjunctival Injection ◽

Complication Rates ◽

Safe Procedure ◽

Success Rates ◽

Whole Process ◽

Before And After

Background. Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies. Methods. We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity. Results. Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results p < 0.001 . For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure. Conclusion. Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.

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Randomized Controlled Trials for Comparison of Laparoscopic Versus Conventional Open Catheter Placement in Peritoneal Dialysis Patients: A Meta-Analysis

10.21203/rs.2.12772/v3 ◽

2020 ◽

Author(s):

Mei-Lan Sun ◽

Yong Zhang(Former Corresponding Author) ◽

Bo Wang ◽

Tean Ma ◽

Hong Jiang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Catheter Placement ◽

Cochrane Library ◽

Controlled Trials ◽

Large Sample Size ◽

Advantages And Disadvantages ◽

Randomized Controlled ◽

Significant Difference

Abstract Aim: The application of laparoscopic catheterization technology in peritoneal dialysis (PD) patients has recently increased. However, the advantages and disadvantages of laparoscopic versus conventional open PD catheter placement are still controversial. The aim of this meta-analysis is to assess the complications of catheterization in PD patients and to provide a reference for choosing a PD-catheter placement technique in the clinic.Methods: We searched numerous databases, including Embase, PubMed, CNKI and the Cochrane Library, for published randomized controlled trials (RCTs).Results: Eight relevant studies (n=646) were included in the meta-analysis. The pooled results showed a lower incidence of catheter migration (OR: 0.42, 95% CI: 0.19 to 0.90, P: 0.03) and catheter removal (OR: 0.41, 95% CI: 0.21 to 0.79, P: 0.008) but a higher incidence of bleeding (OR: 3.25, 95% CI: 1.18 to 8.97, P: 0.02) with a laparoscopic approach than with a conventional approach. There was no significant difference in the incidence of omentum adhesion (OR: 0.32, 95% CI: 0.05 to 2.10, P: 0.24), hernia (OR: 0.38, 95% CI: 0.09 to 1.68, P: 0.20), leakage (OR: 0.69, 95% CI: 0.38 to 1.26, P: 0.23), intestinal obstruction (OR: 0.96, 95% CI: 0.48 to 1.91, P: 0.90) or perforation (OR: 0.95, 95% CI: 0.06 to 15.42, P: 0.97). The statistical analysis showed no significant difference in early (OR: 0.44, 95% CI: 0.15 to 1.33, P: 0.15) , late (OR: 0.89, 95% CI: 0.41 to 1.90, P: 0.76) or total (OR: 0.68, 95% CI: 0.42 to 1.12, P: 0.13) peritonitis infections between the 2 groups, and there are no no significant difference in early ( OR: 0.39, 95% CI: 0.06 to 2.36, P: 0.30), late ( OR: 1.35, 95% CI: 0.78 to 2.33, P: 0.16) or total ( OR: 1.20, 95% CI: 0.71 to 2.02, P: 0.17) tunnel or exit-site infections between the 2 groups.Conclusion: Laparoscopic catheterization and conventional open catheter placement in PD patients have unique advantages, but laparoscopic PD catheterization may be superior to conventional open catheter placement. However, this conclusion needs to be confirmed with further large-sample-size, multi-centre, high-quality RCTs.

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Combination between Mifepristone and Methotrexate to Treat Ectopic Pregnancy: A Systematic Review Protocol

10.1101/2021.09.26.21264155 ◽

2021 ◽

Author(s):

Qiling Su ◽

Huiyan Feng ◽

Tian Tian ◽

Xiaoqian Liao ◽

Yunhui Li ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Controlled Trial ◽

Meta Analysis ◽

Cochrane Library ◽

Secondary Outcome ◽

Control Group ◽

China National Knowledge Infrastructure ◽

Advantages And Disadvantages ◽

Randomized Controlled ◽

Outcome Index

Background: In recent years, the morbidity of ectopic pregnancy and the proportion of young and childless patients have increased year by year, which makes it important to early diagnose EP, effectively save patients' lives and furthest preserve their fertility. Methotrexate and mifepristone are most widely used in conservative treatments, however, there is no accurate conclusion about which therapy is better. Therefore, the aims in this meta-analysis are, on the one hand, to systematically analyze the efficacy of mifepristone combined with methotrexate in the treatment of ectopic pregnancy through existing studies, and to draw scientific conclusions. On the other hand, to fill the gap of relevant analysis in China and abroad, to evaluate the advantages and disadvantages of inclusion trials and propose improvement measures and scientific designing schemes. Methods: Six electronic databases will be searched, including PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure(CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Database (WF). Literature from October 2015 to October 2020 on randomized controlled trials will be searched, without any language or publication restriction. Search terms include mifepristone, methotrexate, ectopic pregnancy, and random (free word/synonym expansion). Included in a randomized controlled trial, the treatment group was treated with mifepristone combined with methotrexate, and the control group was treated with mifepristone alone. Revman 5.4 (provided by Cochrane) will be used to evaluate the quality of the literature, and the corresponding effect model will be selected to analyze the results. The cure rate will be the main outcome index, and the remaining outcome measures after literature inclusion will be the secondary outcome indexes. Result: Only when we finish this meta-analysis can we get the result. Discussion: The results of this study will provide reliable evidence for the efficacy of mifepristone combined with methotrexate therapy in the treatment of ectopic pregnancy.

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Sublobar Resection Versus Ablation for Stage I Non-Small-Cell Lung Cancer: A Meta-Analysis

10.21203/rs.3.rs-247802/v1 ◽

2021 ◽

Author(s):

Yong Li ◽

Fang Yang ◽

Ya-Yong Huang ◽

Tao Wang

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Stage I ◽

Cochrane Library ◽

Complication Rates ◽

Sublobar Resection ◽

Small Cell Lung

Abstract BackgroundStage I non-small-cell lung cancer (NSCLC) can be treated by both ablation and sublobar resection (SR). This meta-analysis was therefore designed to better compare the relative safety and efficacy of these two approaches to treating stage I NSCLC.Materials and MethodsRelevant studies published through November 2020 in the Cochrane Library, Embase, and PubMed databases were identified for analyses which were conducted with RevMan v5.3. ResultsIn total, 816 potentially relevant articles were identified, of which 8 were ultimately included in the final meta-analysis. Patients in the SR group exhibited a signficantly lower pooled local recurrence (LR) rate (5.0% vs. 25.4%, P < 0.0001), although pooled distant recurrence (DR) rates were similar in both groups (25.7% vs. 23.1%, P = 0.75). The pooled hazard ratio (HR) for overall survival (OS) (HR: 1.23; 95% CI: 1.13-1.33, P < 0.00001), progression-free survival (PFS) (HR: 1.34; 95% CI: 1.15-1.55, P = 0.0002), and cancer-specific survival (CSS) (HR: 1.39; 95% CI: 1.15-1.70, P = 0.0009) all indicated better survival outcomes among patients that underwent HR treatment, while pooled complication rates were similar in both groups (27.7% vs. 43.8%, P = 0.27). Patients that underwent ablation exhibited significantly shorter pooled post-operative hospitalization relative to those in the SR group (MD: 5.93; 95% CI: 0.78-11.07, P = 0.02). No evidence of publication bias was detected through funnel plot analyses.ConclusionsSR treatment of stage I NSCLC patients was associated with a lower LR rate and longer survival as compared to ablation.

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Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

BioMed Research International ◽

10.1155/2021/6961540 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Davide Reale ◽

Luca Andriolo ◽

Safa Gursoy ◽

Murat Bozkurt ◽

Giuseppe Filardo ◽

...

Keyword(s):

Tranexamic Acid ◽

Surgical Procedures ◽

Lower Limb ◽

Cruciate Ligament ◽

Meta Analysis ◽

Orthopedic Procedures ◽

Cochrane Library ◽

Complication Rates ◽

Administration Route ◽

Orthopedic Surgical Procedures

Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

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