The safety and efficiency of intravenous administration of tranexamic acid in coronary artery bypass grafting (CABG): a meta-analysis of 28 randomized controlled trials
The safety and efficiency of intravenous administration of tranexamic acid in coronary artery bypass grafting (CABG): a meta-analysis of 28 randomized controlled trials
复制标题
冠状动脉旁路移植术 (CABG) 中静脉注射氨甲环酸的安全性和有效性：28 项随机对照试验的荟萃分析
DOI：
10.1186/s12871-019-0761-3
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发表时间：
2019-06-14
影响因子：
2.2
通讯作者：
Chen, Gang
中科院分区：
文献类型：
--
作者：
Zhang, Yanting;Bai, Yun;Chen, Gang
背景：在冠状动脉旁路移植术（CABG）中静脉注射氨甲环酸（TXA）的安全性和有效性尚未得到证实。因此，我们对这一课题进行了meta分析。方法：我们检索Cochrane中央对照试验注册库（Central）、PUBMED和EMBASE中关于该主题的随机对照试验。这项工作的结果是根据PRISMA声明进行综合和报告的。结果28项研究符合我们的纳入标准。TXA可使术后再手术出血发生率（相对危险度[RR]， 0.46； 95%可信区间[CI]； 0.31-0.68）、异基因输血频率（RR, 0.64; 95% CI, 0.52-0.78）和术后前24 h胸管引流减少206 ml （95% CI:−248.23 ~−164.15）。TXA对术后脑血管意外（RR, 0.93; 95%CI, 0.62-1.39）、死亡率（RR, 0.82; 95%CI, 0.53-1.28）、心肌梗死（RR, 0.90; 95%CI, 0.78-1.05）、急性肾功能不全（RR, 1.01; 95%CI, 0.77-1.32）的发生率无显著影响。然而，它可能增加术后癫痫发作的发生率（RR, 6.67; 95%CI, 1.77-25.20）。此外，有泵和无泵CABG的亚组分析、随机受试者超过99人的试验的敏感性分析以及排除受试者最多的研究的敏感性分析进一步强化了上述结果。结论stxa可有效减少冠状动脉搭桥术患者的再手术出血、失血和异体血液制品的需求，且不增加血栓前并发症。然而，它可能会增加术后癫痫发作的风险。
BackgroundThe safety and efficiency of intravenous administration of tranexamic acid (TXA) in coronary artery bypass grafting (CABG) remains unconfirmed. Therefore, we conducted a meta-analysis on this topic.MethodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED and EMBASE for randomized controlled trials on the topic. The results of this work are synthetized and reported in accordance with the PRISMA statement.ResultsTwenty-eight studies met our inclusion criteria. TXA reduced the incidence of postoperative reoperation of bleeding (relative risk [RR], 0.46; 95% confidence interval [CI]; 0.31–0.68), the frequency of any allogeneic transfusion (RR, 0.64; 95% CI, 0.52–0.78) and the postoperative chest tube drainage in the first 24 h by 206 ml (95% CI − 248.23 to − 164.15). TXA did not significantly affect the incidence of postoperative cerebrovascular accident (RR, 0.93; 95%CI, 0.62–1.39), mortality (RR, 0.82; 95%CI, 0.53–1.28), myocardial infarction (RR, 0.90; 95%CI, 0.78–1.05), acute renal insufficiency (RR, 1.01; 95%CI, 0.77–1.32). However, it may increase the incidence of postoperative seizures (RR, 6.67; 95%CI, 1.77–25.20). Moreover, the subgroup analyses in on-pump and off-pump CABG, the sensitivity analyses in trials randomized more than 99 participants and sensitivity analyses that excluded the study with the largest number of participants further strengthened the above results.ConclusionsTXA is effective to reduce reoperation for bleeding, blood loss and the need for allogeneic blood products in patients undergoing CABG without increasing prothrombotic complication. However, it may increase the risk of postoperative seizures.