Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature
Reduced blood loss after intra-articular tranexamic acid injection during total knee arthroplasty: a meta-analysis of the literature
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DOI：
10.1007/s00167-013-2814-3
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发表时间：
2014-12-01
影响因子：
3.8
通讯作者：
Zhang Ying-ze
中科院分区：
文献类型：
--
作者：
Chen Zhao-yu;Gao Yan;Zhang Ying-ze
本研究的目的是对评价关节内注射氨甲环酸（TXA）减少全膝关节置换术（TKA）患者失血和输血的有效性和安全性的随机对照试验进行荟萃分析，对2013年3月之前发表的RCT进行荟萃分析，这些RCT来自PubMed、EMBase、科克伦图书馆、ScienceDirect和其他数据库。两名独立的评审员评估了研究的方法学质量并进行了数据提取。从纳入的研究中汇总TXA治疗组与安慰剂组之间失血和输血的平均差异、输血率的风险比和深静脉血栓形成（DVT）发生率。数据采用Stata 11.0软件进行分析，共纳入6个研究，总样本量为647例患者。TXA的使用显著降低了总失血量（平均差异：-344.96; 95%置信区间（CI）-401.20至-239.68; P < 0.01）和需要输血的患者比例（风险比，0.28; 95% CI：0.19-0.42; P < 0.01）。研究组之间DVT、肺栓塞或其他并发症的发生率无显著差异。本荟萃分析表明，接受TKA的患者关节内注射TXA可减少总失血量和输血需求，特别是在使用高剂量TXA时（千分之一日元30毫克/毫升），而不会增加术后DVT的风险。
The purpose of the study is to conduct a meta-analysis of randomized, controlled trials evaluating the efficacy and safety of intra-articular injection of tranexamic acid (TXA) for reducing blood loss and transfusion in patients undergoing total knee arthroplasty (TKA).A meta-analysis was conducted of RCTs published before March 2013, identified from the PubMed, EMBase, Cochrane library, ScienceDirect, and other databases. Two independent reviewers assessed the methodological quality of the studies and performed data extraction. Mean difference in blood loss and blood transfusions, risk ratios of transfusion rates, and deep vein thrombosis (DVT) incidence in the TXA-treated group versus placebo group were pooled from the included studies. Data were analysed using Stata 11.0 software.Six studies were included, with a total sample size of 647 patients. The use of TXA significantly reduced total blood loss (mean difference: -344.96; 95 % confidence interval (CI) -401.20 to -239.68; P < 0.01) and the proportion of patients requiring blood transfusions (risk ratios, 0.28; 95 % CI: 0.19-0.42; P < 0.01). There were no significant differences in the incidence of DVT, pulmonary embolism, or other complications between the study groups.The present meta-analysis indicated that intra-articular injection of TXA in patients undergoing TKA may reduce total blood loss and the need for blood transfusions, particularly when a high dosage of TXA is used (a parts per thousand yen30 mg/ml), without any increase in the risk of post-operative DVT.II.