Wei Z, Liu M
Department of Trauma, Union Medicine Centre of Tianjin, Tianjin, China.
Transfus Med. 2015 Jun;25(3):151-62. doi: 10.1111/tme.12212. Epub 2015 May 29.
To evaluate the safety and efficacy of tranexamic acid (TXA) in total knee arthroplasty (TKA) and total hip arthroplasty (THA). The specific endpoints assessed in this meta-analysis include the total blood loss, the incidence rate of deep vein thrombosis (DVT) and pulmonary embolisms (PE), the number of patients requiring at least 1 U of red blood cell following surgery.
The prevalence of THA and TKA is increasing and both are usually accompanied by considerable blood loss. TXA has been reported to reduce total blood loss in many orthopaedic surgeries. TXA administration continues to be a controversial topic in the literature about joint arthroplasty, and many studies have reported substantial doubt with respect to its benefits and safety.
METHODS/MATERIALS: We conducted a meta-analysis that combined all data from available randomised controlled trials, regardless the methods of TXA administration, which included administrated intravenously, intra-articularly, topically or orally. Finally, available data from the 39 included trials were pooled for analysis. Then, mean differences with 95% confidence intervals (CIs) was calculated for continuous outcomes and relative risks with 95% CIs for dichotomous outcomes.
This meta-analysis suggests that the administration of TXA significantly reduced blood loss and the need for allogeneic blood transfusion, without apparent increased risk of DVT or PE thromboembolic complications.
To our knowledge, this meta-analysis is more powerful and persuasive than any other published before. It suggests that the use of TXA reduced the risk of blood loss and the need for allogeneic blood transfusion significantly, without apparent increased risk of DVT or PE complications.
评估氨甲环酸（TXA）在全膝关节置换术（TKA）和全髋关节置换术（THA）中的安全性和有效性。本荟萃分析评估的具体终点包括总失血量、深静脉血栓形成（DVT）和肺栓塞（PE）的发生率、术后至少需要1单位红细胞的患者数量。
THA和TKA的患病率正在上升，且两者通常都伴有大量失血。据报道，TXA可减少许多骨科手术中的总失血量。在关于关节置换术的文献中，TXA的使用仍然是一个有争议的话题，许多研究对其益处和安全性表示了极大的怀疑。
方法/材料：我们进行了一项荟萃分析，汇总了所有可用随机对照试验的数据，无论TXA的给药方法如何，包括静脉内、关节内、局部或口服给药。最后，将39项纳入试验的可用数据进行汇总分析。然后，计算连续结果的95%置信区间（CI）的平均差异和二分结果的95%CI的相对风险。
本荟萃分析表明，TXA的使用显著减少了失血量和异体输血的需求，且DVT或PE血栓栓塞并发症的风险没有明显增加。
据我们所知，这项荟萃分析比以往发表的任何其他分析都更有说服力。它表明，使用TXA可显著降低失血风险和异体输血的需求，且DVT或PE并发症的风险没有明显增加。
