Shemshaki Hamidreza, Nourian Sayed Mohammad Amin, Nourian Niloofaralsadat, Dehghani Masoudhatef, Mokhtari Masoud, Mazoochian Farhad
Orthopaedic Surgery Department, Crona Clinik, Eberhard Karls University, Tuebingen, Germany,
Arch Orthop Trauma Surg. 2015 Apr;135(4):573-88. doi: 10.1007/s00402-015-2189-7. Epub 2015 Mar 5.
Tranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding.
This study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated.
Compared to the control, the IA administration of TXA led to the significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and reduction of rate of thromboembolic events (p = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and rate of thromboembolic events (p = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events.
This study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.
氨甲环酸（TXA）在骨科领域因其有效性和易用性，在静脉注射（IV）和关节内注射（IA）应用中近来备受青睐。然而，由于静脉给药存在安全问题，人们对IA使用TXA预防出血的兴趣日益浓厚。
本研究进行了一项系统评价和荟萃分析，纳入31项随机对照试验，研究全身和局部使用TXA对总失血量（TBL）、输血率和血栓栓塞事件的影响。
与对照组相比，IA使用TXA导致平均TBL显著降低（p < 0.001）、输血率降低（p < 0.001）以及血栓栓塞事件发生率降低（p = 0.29）。与对照组相比，IV使用TXA导致平均TBL显著降低（p < 0.001）、输血率降低（p < 0.001）以及血栓栓塞事件发生率降低（p = 0.66）。虽然未发现IA和IV使用TXA在疗效和安全性上有显著差异，但IA方法在降低输血率和血栓栓塞事件方面比IV方法更安全。
本研究表明，TXA可显著降低TBL和异体输血率。总体而言，未检测到IA和IV使用TXA之间存在显著差异；然而，仍需要更多关注安全性和有效性的研究。
