Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review.
Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review.
复制标题
氨甲环酸在双侧全膝关节置换术中的疗效和安全性：荟萃分析和系统评价
DOI：
10.12659/msm.895027
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发表时间：
2015-11-24
期刊：
影响因子：
--
通讯作者：
Wang H
中科院分区：
文献类型：
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作者：
He P;Zhang Z;Li Y;Xu D;Wang H
氨甲环酸（TXA）已被充分证明可以减少单侧全膝关节置换术（TKA）患者的失血量和输血需求。然而，TXA在同时双侧TKA中的有效性和安全性尚未明确定义。我们研究的目的是系统地回顾关于TXA在同时接受双侧TKA的患者中的作用的现有证据。材料/方法使用Medline、EMBASE、奥维德和其他数据库对截至2014年6月发表的所有研究进行系统检索。确定了所有比较TXA给药在同时双侧TKA患者中的有效性和安全性的研究。从纳入的试验中提取数据，并分析失血量和输血率。使用分级系统评价所选文章的证据质量水平。结果共纳入6个研究，其中245例患者接受了TXA治疗，271例患者为对照组。总体而言，结果表明，使用TXA显著减少了总失血量，平均为371.1 ml（95%置信区间（CI）=−412.12至−330.09; p<0.001），并减少了需要输血的患者数量（风险比（RR）=0.16; 95% CI=0.10至0.28; p<0.001）。在任何组中，深静脉血栓形成（DVT）或肺栓塞（PE）等不良反应均无显著差异。结论双侧TKA患者静脉应用TXA是安全有效的，可显著减少估计失血量和输血率。副作用的发生率无显著差异。由于目前荟萃分析的证据质量有限，需要进行良好的、更大规模的、高质量的随机对照试验（RCT）。
Background Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. Material/Methods A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. Results Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=−412.12 to −330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. Conclusions The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.