Identifying an effective Chinese herbal medicine for reducing postoperative hidden bleeding and stabilizing blood volume following intertrochanteric femur fracture: a Bayesian network meta-analysis of randomized controlled trials.

Objective: Chinese herbal medicine (CHM) is extensively utilized in managing hidden bleeding following an intertrochanteric femur fracture (IFF). Despite its widespread use, the most effective CHM approach for addressing hidden bleeding post-IFF remains unclear. A Bayesian network meta-analysis was conducted to identify a CHM that both effectively reduces hidden bleeding and stabilizes blood volume after IFF.

Methods: Comprehensive electronic searches were performed on databases in both Chinese and English, including the Chinese National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform (Wanfang), China Science and Technology Journal Database (VIP), PubMed, Web of Science, and Cochrane Library. All randomized controlled trials (RCTs) employing CHM to address hidden bleeding post-IFF, up to December 31, 2023, were thoroughly reviewed. The analysis utilized Stata17.0 and Review Manager 5.4 software, tailored to the frequentist framework.

Results: Thirty-one articles were included, encompassing 17 interventions and 2076 patients. The systematic analysis revealed that: For improving postoperative haemoglobin (HB), the top three interventions were conventional treatment combined with Yiqi Buxue decoction, Yangxue Rougan decoction, and Sanqi powder; For reducing hidden bleeding post-surgery, the leading interventions were conventional treatment combined with Siwu decoction, Yangxue Rougan decoction, and Qitian Keli prescription; For enhancing the Harris score, the top interventions were conventional treatment combined with Bazhen decoction, Danggui Buxue decoction, and Sanqi powder; Descriptive analysis indicated minimal adverse reactions and enhanced safety overall.

Conclusion: CHM presents a viable method for treating hidden blood loss after IFF. Yangxue Rougan decoction notably excels in reducing hidden bleeding and stabilizing HB levels, making it a preferred option. Nevertheless, further rigorous RCT studies are essential to compare various CHM treatments to establish the most effective options for clinicians. PROSPERO registration number CRD42023489292.