Fu De-Jie, Chen Cheng, Guo Lin, Yang Liu
Centre for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Chin J Traumatol. 2013;16(2):67-76.
The effect of tranexamic acid (TA) on patients receiving total knee arthroplasty (TKA) has been reported in many small clinical trials. But single trials are not sufficient enough to clarify the effectiveness and safety of TA. So, we carried out a meta-analysis of randomized controlled trials to investigate the efficacy and safety of the intravenous use of TA in TKA.
Literatures were retrieved in Cochrane Library, OVID, PubMed, EMBASE, CNKI and Wanfang Data. All the related literatures were checked by two independent investigators and only the high quality randomized controlled trials were enrolled. Relevant data were analyzed using RevMan 5.1 to compare the difference of blood loss, transfusion and complications between TA group and control group.
There were 353 related literatures and only 22 randomized controlled trials met the inclusion criteria. The use of TA in TKA significantly reduced total blood loss by a mean of 435.41 ml (95% CI 300.62-570.21, P less than 0.01), post-operative blood loss by a mean of 406.69 ml (95% CI 333.16-480.22, P less than 0.01). TA also significantly lowered the transfusion rate (risk difference 0.30, 95% CI 0.21-0.39, P less than 0.01) and transfusion volume (mean difference 0.95 unit, 95% CI 0.53-1.37, P less than 0.01). The risks between TA group and control group in developing deep vein thrombosis and pulmonary embolism were not statistically significant.
TA is beneficial for patients undergoing TKA, which can significantly reduce total blood loss, postoperative blood loss, transfusion rate, and transfusion volume. Meanwhile TA is recommended to reduce deep vein thrombosis and pulmonary embolism following TKA.
许多小型临床试验已报道了氨甲环酸（TA）对接受全膝关节置换术（TKA）患者的影响。但单个试验不足以阐明TA的有效性和安全性。因此，我们进行了一项随机对照试验的荟萃分析，以研究静脉使用TA在TKA中的疗效和安全性。
在Cochrane图书馆、OVID、PubMed、EMBASE、中国知网和万方数据中检索文献。所有相关文献由两名独立研究者进行筛选，仅纳入高质量的随机对照试验。使用RevMan 5.1分析相关数据，比较TA组和对照组之间失血、输血及并发症的差异。
共检索到353篇相关文献，仅22项随机对照试验符合纳入标准。TKA中使用TA可显著减少总失血量，平均减少435.41 ml（95%可信区间300.62 - 570.21，P < 0.01），术后失血量平均减少406.69 ml（95%可信区间333.16 - 480.22，P < 0.01）。TA还显著降低了输血率（风险差0.30，95%可信区间0.21 - 0.39，P < 0.01）和输血量（平均差0.95单位，95%可信区间0.53 - 1.37，P < 0.01）。TA组和对照组发生深静脉血栓形成和肺栓塞的风险无统计学差异。
TA对接受TKA的患者有益，可显著减少总失血量、术后失血量、输血率和输血量。同时，推荐使用TA以降低TKA后深静脉血栓形成和肺栓塞的发生风险。
