The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial.
The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial.
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DOI：
10.1186/s13018-020-01983-1
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发表时间：
2020-10-06
影响因子：
2.6
通讯作者：
Shao J
中科院分区：
文献类型：
--
作者：
Ye W;Liu Y;Liu WF;Li XL;Shao J
口服氨甲环酸（TXA）已被证明可以减少初次全膝关节和髋关节置换术中的失血量，但口服TXA的最佳给药方案仍不清楚。本研究旨在寻找初次全膝关节和髋关节置换术中口服TXA的最佳给药次数。检索PubMed、Embase和科克伦图书馆数据库中2020年3月20日之前发表的相关研究。纳入了明确报告比较全髋关节/膝关节置换术中多次口服TXA给药的研究，并评价了总失血量（TBL）、术中失血量（IBL）、血红蛋白下降（DHB）、深静脉血栓形成（DVT）、肌内静脉血栓形成（IVT）、住院时间（LOS）和输血率。使用固定效应或随机效应模型计算加权平均差异和相对风险。本荟萃分析纳入了9项研究，共1678例患者（TXA 1363（1次给药，201例; 2次给药，496例; 3次给药，215例; 4次给药，336例; 5次给药，115例）;安慰剂组315例）;结果显示，与安慰剂组相比，口服TXA可显著降低TBL、IBL、DHB、LOS和输血率。此外，TXA组和安慰剂组的IVT和DVT发生率相似。此外，口服TXA两次给药与一次给药相比显著降低了TBL和DHB，口服TXA三次给药优于两次给药，口服TXA四次给药优于三次给药。我们的研究结果表明，口服TXA可以显着减少失血量和住院时间，但不会增加DVT和IVT的发生率为全关节置换术患者;此外，口服TXA管理的有效性增加的管理次数增加。
Oral tranexamic acid (TXA) has been demonstrated to reduce the blood loss in primary total knee and hip arthroplasty, but the optimal regimen of oral TXA administration is still unknown. This study aimed to find the best number of administrations of oral TXA for primary total knee and hip arthroplasty. The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published before March 20, 2020. Studies clearly reporting a comparison of multiple administrations of oral TXA for total hip/knee replacement were included, and the total blood loss (TBL), intraoperative blood loss (IBL), decline in hemoglobin (DHB), deep vein thrombosis (DVT), intramuscular venous thrombosis (IVT), length of hospital stay (LOS), and transfusion rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed effects or random effects model. Nine studies involving 1678 patients were included in this meta-analysis (TXA 1363 (one administration, 201; two administrations, 496; three administrations, 215; four administrations, 336; five administrations, 115); placebo 315); the results show that compared with placebo groups, oral TXA could significantly reduce the TBL, IBL, DHB, LOS, and transfusion rate. In addition, the incidences of IVT and DVT were similar between the TXA and placebo groups. Moreover, two administrations of oral TXA significantly reduced the TBL and DHB compared with one administration, three administrations of oral TXA were better than two administrations, and four administrations of oral TXA were better than three administrations. Our results suggested that oral TXA could significantly reduce the blood loss and the length of hospital stay but could not increase the incidence of DVT and IVT for total joint replacement patients; additionally, the effectiveness of oral TXA administration increased as the number of administrations increased.
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