Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta-Analysis of Randomized, Controlled Trials and Cohort Studies
Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta-Analysis of Randomized, Controlled Trials and Cohort Studies
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DOI：
10.1111/bcpt.12847
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发表时间：
2018-01-01
影响因子：
3.1
通讯作者：
Sivaramakrishnan, Gowri
中科院分区：
文献类型：
--
作者：
Sridharan, Kannan;Sivaramakrishnan, Gowri
临床研究显示氨甲环酸（TXA）对全膝关节置换术（TKA）患者有效，但对于最合适的给药途径尚未达成共识。我们进行了网络荟萃分析，以比较 TXA 在 TKA 中的有效性和安全性的现有证据。在电子数据库中搜索了评估 TXA 在 TKA 中的随机临床试验和队列研究。评估了发表偏倚、偏倚风险和不一致。对输血率和血栓并发症发生率进行直接和间接比较。对关键比较进行了敏感性分析和证据分级。进行累积荟萃分析以进行至少 10 项纳入研究的比较。此次网络荟萃分析汇集了 19 项研究，共有 8916 名参与者。没有观察到不一致和发表偏倚。大多数纳入研究的偏倚风险较低。与安慰剂相比，混合治疗分析的汇总估计值倾向于（按较高顺序排列）术前口服和局部 TXA 组合、术中静脉 TXA 与局部 TXA、术前静脉 TXA、术中和术后静脉 TXA、术中静脉推注和局部 TXA。此外，静脉注射和局部 TXA 联合治疗的效果优于单独局部 TXA。敏感性分析中未观察到显着变化。干预措施之间的血栓并发症风险没有观察到显着差异。 TXA 对 TKA 患者有效且安全。联合局部和术中静脉注射 TXA 可能效果更好。
Tranexamic acid (TXA) has been shown to be effective in patients with total knee arthroplasty (TKA) in clinical studies with no consensus with regard to the most appropriate route of administration. We conducted a network meta-analysis to compare the evidence available on efficacy and safety of TXA in TKA. Electronic databases were searched for randomized, clinical trials and cohort studies that evaluated TXA in TKA. Publication bias, risk of bias and inconsistencies were assessed. Direct and indirect comparisons were carried out for blood transfusion rate and incidence of thrombotic complications. Sensitivity analyses and grading of evidence were performed for key comparisons. A cumulative meta-analysis was conducted for comparisons that had a minimum of 10 included studies. A total of 19 studies with 8916 participants were pooled for this network meta-analysis. No inconsistencies and publication bias were observed. Low risk of bias was observed for the majority of the included studies. When compared to placebo, the pooled estimates for mixed treatment analyses favoured (in the order of higher ranking) the combined pre-operative oral and topical TXA, intra-operative intravenous TXA with topical TXA, pre-operative intravenous TXA, intra-operative and post-operative intravenous TXA, intra-operative intravenous bolus and topical TXA. Additionally, combined intravenous and topical TXA performed better than topical TXA alone. No significant changes were observed in the sensitivity analyses. No significant differences were observed in the risk of thrombotic complications between the interventions. TXA is efficacious and safe in patients with TKA. The combined topical and intra-operative intravenous TXA may perform better.