The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis.
The efficacy and safety of tranexamic acid in revision total knee arthroplasty: a meta-analysis.
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氨甲环酸在全膝关节翻修术中的疗效和安全性：荟萃分析
DOI：
10.1186/s12891-017-1633-y
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发表时间：
2017-06-21
影响因子：
2.3
通讯作者：
Ma XL
中科院分区：
文献类型：
--
作者：
Tian P;Liu WB;Li ZJ;Xu GJ;Huang YT;Ma XL
关于静脉注射氨甲环酸(TXA)减少翻修全膝关节置换术(TKA)出血的有效性和安全性，尚无一致的结论。我们进行了一项比较试验的荟萃分析，以评估TXA在翻修TKA中的有效性和安全性。我们在PubMed、EMBASE、Cochrane图书馆和Web of Science上搜索随机对照试验(RCT)和非随机对照试验。两位作者选择了这些研究，提取了数据，并独立评估了偏倚的风险。采用Revman 5.3软件进行汇总荟萃分析。四个非随机对照试验符合纳入标准。Meta分析显示，血栓素A的使用与输血需求显著减少(RD=−321.07；95%CI：-0.43对−0.08；P=0.005)、引流量(MD=0.025；95%CI：-445.13至−197.01，P=0.005)、降低血红蛋白(MD=0.79；95%CI：-0.79至−0.25，P=0.0001)、住院天数(MD=445.13至−197.01，P=0.005)有关；95%CI：-4.00，−为0.71，P=0.005)。深静脉血栓形成(DVT)或肺栓塞(PE)的发生率没有显著差异。对于接受TKA翻修术的患者，使用TXA可以减少失血量和输血量，而不会增加术后静脉血栓形成的风险。由于目前现有证据的质量有限，需要更多高质量的随机对照试验。
There is no consistent conclusion regarding the efficacy and safety of the intravenous administration of tranexamic acid (TXA) for reducing blood loss in revision total knee arthroplasty (TKA). We performed a meta-analysis of comparative trials to evaluate the efficacy and safety of TXA in revision TKA. We conducted a search of PubMed, EMBASE, The Cochrane Library and Web of Science for randomized controlled trials (RCTs) and non-RCTs. Two authors selected the studies, extracted the data, and assessed the risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software. Four non-RCTs met the inclusion criteria. The meta-analysis indicated that the use of TXA was related to significantly less transfusion requirements (RD = −0.25; 95% CI: -0.43 to −0.08; P = 0.005), drainage volume (MD = −321.07; 95% CI: -445.13 to −197.01, P = 0.005), hemoglobin reduction (MD = −0.52; 95% CI: -0.79 to −0.25, P = 0.0001), and length of hospital stay (MD = −2.36; 95% CI: -4.00 to −0.71, P = 0.005). No significant differences in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were noted. The use of TXA for patients undergoing revision TKA may reduce blood loss and transfusion requirements without increasing the risk of postoperative venous thromboembolism. Due to the limited quality of the currently available evidence, more high-quality RCTs are required.