Yue Chen, Pei Fuxing, Yang Peiqing, Xie Jinwei, Kang Pengde
Orthopedics. 2015 May;38(5):315-24. doi: 10.3928/01477447-20150504-06.
Intravenous tranexamic acid (TXA) has been identified to be effective in total knee arthroplasty (TKA), but the effect of topical application is still unclear. Therefore, the authors conducted a meta-analysis to assess the effect of topical TXA in TKA. Twelve trials with a total of 1179 knees were included. The results revealed that the application of topical TXA in TKA significantly reduced total blood loss by a mean of 280.65 mL and reduced transfusions without increasing the risks of deep venous thrombosis and pulmonary embolism. Topical TXA also reduced postoperative drain output by a mean of 194.59 mL and lowered postoperative hemoglobin drop by a mean of 0.66 g/dL. In addition, subgroup analysis showed that high-concentration TXA may be better at reducing bleeding and transfusions than low-concentration TXA. Therefore, the authors concluded that topical TXA can effectively reduce bleeding and transfusion rate in TKA without increasing the risk of deep venous thrombosis and pulmonary embolism, and high-concentration (20 mg/mL or more) topical TXA is recommended.
静脉注射氨甲环酸（TXA）已被证实对全膝关节置换术（TKA）有效，但局部应用的效果仍不明确。因此，作者进行了一项荟萃分析，以评估局部应用TXA在TKA中的效果。共纳入12项试验，涉及1179个膝关节。结果显示，在TKA中局部应用TXA可显著减少总失血量，平均减少280.65 mL，并减少输血，且不增加深静脉血栓形成和肺栓塞的风险。局部应用TXA还可使术后引流量平均减少194.59 mL，并使术后血红蛋白下降平均降低0.66 g/dL。此外，亚组分析表明，高浓度TXA在减少出血和输血方面可能比低浓度TXA更好。因此，作者得出结论，局部应用TXA可有效降低TKA中的出血和输血率，且不增加深静脉血栓形成和肺栓塞的风险，建议使用高浓度（20 mg/mL或更高）的局部TXA。
