Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
J Surg Res. 2014 Jan;186(1):318-27. doi: 10.1016/j.jss.2013.08.020. Epub 2013 Sep 13.
Conflicting reports have been published regarding the effect of tranexamic acid (TXA) on reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of TXA treatment in reducing blood loss and transfusion in major orthopedic surgery.
MEDLINE, PubMed, EMBASE, and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, number of transfusions per patient, and the summary risk ratio of transfusion and deep vein thrombosis (DVT) were calculated in the TXA-treated group and the control group.
A total of 46 randomized controlled trials involving 2925 patients were included. The use of TXA reduced total blood loss by a mean of 408.33 mL (95% confidence interval [CI], -505.69 to -310.77), intraoperative blood loss by a mean of 125.65 mL (95% CI, -182.58 to -68.72), postoperative blood loss by a mean of 214.58 mL (95% CI, -274.63 to -154.52), the number of blood transfusions per patient by 0.78 U (95% CI, -0.19 to -0.37), and the volumes of blood transfusions per patient by 205.33 mL (95% CI, -301.37 to -109.28). TXA led to a significant reduction in transfusion requirements (relative risk, 0.51; 95% CI, 0.46-0.56), and no increase in the risk of DVT (relative risk, 1.11; 95% CI, 0.69-1.79).
TXA significantly reduced blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and did not appear to increase the risk of DVT.
关于氨甲环酸（TXA）在减少骨科手术患者失血和输血方面的效果，已有相互矛盾的报道。我们进行了一项荟萃分析，以评估 TXA 治疗在减少主要骨科手术中失血和输血方面的有效性和安全性。
检索 MEDLINE、PubMed、EMBASE 和 Cochrane 数据库，以查找相关研究。只有随机对照试验才有资格进行本研究。在 TXA 治疗组和对照组中计算了失血的加权均数差值、每位患者的输血次数以及输血和深静脉血栓形成（DVT）的汇总风险比。
共纳入 46 项随机对照试验，涉及 2925 名患者。使用 TXA 可使总失血量平均减少 408.33 mL（95%置信区间 [CI]，-505.69 至 -310.77），术中失血量平均减少 125.65 mL（95% CI，-182.58 至 -68.72），术后失血量平均减少 214.58 mL（95% CI，-274.63 至 -154.52），每位患者的输血次数减少 0.78 U（95% CI，-0.19 至 -0.37），每位患者的输血体积减少 205.33 mL（95% CI，-301.37 至 -109.28）。TXA 显著降低了输血需求（相对风险，0.51；95% CI，0.46-0.56），且并未增加 DVT 的风险（相对风险，1.11；95% CI，0.69-1.79）。
TXA 可显著减少骨科手术患者的失血量和输血需求，且似乎不会增加 DVT 的风险。
