Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis.
Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis.
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DOI：
10.3389/fphar.2022.887386
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发表时间：
2022
影响因子：
5.6
通讯作者：
Li, Jin
中科院分区：
文献类型：
--
作者：
Hong, Pan;Liu, Ruikang;Rai, Saroj;Liu, JiaJia;Ding, Yuhong;Li, Jin
背景：氨甲环酸（TXA）已应用于各种类型的手术中用于止血目的。 TXA的有效性和安全性在不同手术中仍存在争议。需要 TXA 的临床应用指南。 材料和方法：我们系统地检索了多个医学数据库，进行荟萃分析，检查 TXA 的有效性和安全性。手术类型包括关节置换手术、其他骨科手术、心脏手术、脑外科等。结果包括失血量、输血、不良事件、再次手术率、手术时间和住院时间、血红蛋白（Hb）水平和凝血功能。系统评价 2 (AMSTAR 2) 的方法学质量评估和建议、评估、制定和评价分级 (GRADE) 用于对纳入的荟萃分析进行质量评估。通过计算修正覆盖面积（CCA）来评估重叠评论。 结果：我们总共确定了 47 项荟萃分析，其中 44 项具有“高”质量。总共评估了 319 个结果，其中 58 个结果被评估为“高”质量。 TXA在各种手术中表现出显着的止血效果，具有较低的输血率和再次手术率、较短的手术时间和住院时间以及较高的血红蛋白水平。此外，TXA不会增加死亡和血管不良事件的风险，但它是心脏手术中癫痫发作（神经系统事件）的危险因素。 结论：我们的研究表明TXA具有一般的止血效果，不良事件很少，这表明TXA是预防过度出血和减少输血率的推荐药物。我们还针对不同类型的成人手术推荐不同剂量的 TXA。然而，由于实验设计的异质性，我们无法为不同的手术推荐统一的剂量。 系统审查注册：clinicaltrials.gov/，标识符 CRD42021240303
Background: Tranexamic acid (TXA) has been applied in various types of surgery for hemostasis purposes. The efficacy and safety of TXA are still controversial in different surgeries. Guidelines for clinical application of TXA are needed. Materials and method: We systematically searched multiple medical databases for meta-analyses examining the efficacy and safety of TXA. Types of surgery included joint replacement surgery, other orthopedic surgeries, cardiac surgery, cerebral surgery, etc. Outcomes were blood loss, blood transfusion, adverse events, re-operation rate, operative time and length of hospital stay, hemoglobin (Hb) level, and coagulation function. Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used for quality assessment of the included meta-analyses. Overlapping reviews were evaluated by calculating the corrected covered area (CCA). Result: In all, we identified 47 meta-analyses, of which 44 of them were of “high” quality. A total of 319 outcomes were evaluated, in which 58 outcomes were assessed as “high” quality. TXA demonstrates significant hemostatic effects in various surgeries, with lower rates of blood transfusion and re-operation, shorter operative time and length of stay, and higher Hb levels. Besides, TXA does not increase the risk of death and vascular adverse events, but it is a risk factor for seizure (a neurological event) in cardiac surgery. Conclusion: Our study demonstrates that TXA has a general hemostatic effect with very few adverse events, which indicates TXA is the recommended medication to prevent excessive bleeding and reduce the blood transfusion rate. We also recommend different dosages of TXA for different types of adult surgery. However, we could not recommend a unified dosage for different surgeries due to the heterogeneity of the experimental design. Systematic Review Registration: clinicaltrials.gov/, identifier CRD42021240303
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