Efficacy and safety of oral tranexamic acid in total knee arthroplasty: A systematic review and meta-analysis.
Efficacy and safety of oral tranexamic acid in total knee arthroplasty: A systematic review and meta-analysis.
复制标题
口服氨甲环酸在全膝关节置换术中的疗效和安全性：系统评价和荟萃分析
DOI：
10.1097/md.0000000000010587
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发表时间：
2018-05
期刊：
影响因子：
1.6
通讯作者：
Cheng L
中科院分区：
文献类型：
--
作者：
Guo P;He Z;Wang Y;Gao F;Sun W;Guo W;Li Z;Cheng L
氨甲环酸（TXA）是一种抗纤溶药物，广泛用于全膝关节置换术（TKA）中的血液保护技术，通常通过静脉或关节内注射给药。最近，口服形式的TXA已应用于TKA患者。然而，关于口服TXA的有效性和安全性尚未达成最终共识。本随机对照试验（RCT）的系统性综述和荟萃分析旨在评价口服TXA与对照治疗TKA后失血的有效性和安全性。我们检索了截至2017年8月的PubMed、Embase、Medline、Web of Science和科克伦图书馆数据库中的相关研究。在整个研究期间，汇总TXA组和对照组的总失血量、血红蛋白（Hb）下降、红细胞压积（Hct）、引流量的平均差异（MD）以及输血率和血栓栓塞并发症的风险差异（RD）。通过Stata 12.0汇总结局。本研究共纳入5项RCT（608例患者）。所有纳入研究均为随机研究，纳入研究质量较高。汇总结果表明，口服TXA组的Hb下降明显较少，（标准化均值差[SMD]，−0.936; 95%置信区间[CI]，−1.118，−0.754），Hct下降（SMD，−0.693; 95%CI，−1.113，−0.274）和漏极输出（SMD，−0.793; 95%CI，−0.959，−0.628）。两组之间的输血率和血栓栓塞并发症的发生率无统计学显著差异。由于日期不足，无法评价总失血量。我们的荟萃分析表明，口服TXA在Hb下降、Hct下降和引流量方面提供了显著更好的结果，而不会增加TKA后的输血率和血栓栓塞并发症的风险。然而，我们目前的研究存在一些局限性，例如样本量小，只能提供有限的证据质量，需要通过大规模、精心设计的随机对照试验进行进一步荟萃分析来证实。
Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by intravenous or intraarticular injection. Recently, the oral form of TXA has been applied in TKA patients. However, there is no final consensus regarding the effectiveness and safety of oral TXA. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of oral TXA versus control for blood loss after TKA. We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases for relevant studies through August 2017. The mean difference (MD) of total blood loss, hemoglobin (Hb) drop, hematocrit (Hct), drain output, and risk difference (RD) of transfusion rate and thromboembolic complications in the TXA and control groups were pooled throughout the study. The outcomes were pooled by Stata 12.0. A total of 5 RCTs (608 patients) were included in this study. All the included studies were randomized and the quality of included studies was relatively high. The pooled results indicated that the oral TXA group had significantly less Hb drop (standardized mean difference [SMD], −0.936; 95% confidence intervals [CI], −1.118,−0.754), Hct drop (SMD, −0.693; 95% CI, −1.113, −0.274), and drain output (SMD, −0.793; 95% CI, −0.959, −0.628) than the control group. No statistically significant differences were found in transfusion rate and the incidence of thromboembolic complications between the 2 groups. Total blood loss could not be evaluated for the insufficient date. Our meta-analysis suggested that the administration of oral TXA provided significantly better results with respect to Hb drop, Hct drop, and drain output without increasing the transfusion rate and the risk of thromboembolic complications after TKA. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.