Wang Hao, Shen Bin, Zeng Yi
Orthopedics. 2015 Nov;38(11):e1007-16. doi: 10.3928/01477447-20151020-10.
There has been much debate and controversy about the safety and efficacy of the topical use of tranexamic acid in primary total knee arthroplasty (TKA). The purpose of this study was to perform a meta-analysis to evaluate whether there is less blood loss and lower rates of transfusion after topical tranexamic acid administration in primary TKA. A systematic review of the electronic databases PubMed, CENTRAL, Web of Science, and Embase was undertaken. All randomized, controlled trials and prospective cohort studies evaluating the effectiveness of topical tranexamic acid during primary TKA were included. The focus of the analysis was on the outcomes of blood loss results, transfusion rate, and thromboembolic complications. Subgroup analysis was performed when possible. Of 387 studies identified, 16 comprising 1421 patients (1481 knees) were eligible for data extraction and meta-analysis. This study indicated that when compared with the control group, topical application of tranexamic acid significantly reduced total drain output (mean difference, -227.20; 95% confidence interval, -347.11 to -107.30; P<.00001), total blood loss (mean difference, -311.28; 95% confidence interval, -404.94 to -217.62; P<.00001), maximum postoperative hemoglobin decrease (mean difference, -0.73; 95% confidence interval, -0.96 to -0.50; P<.00001), and blood transfusion requirements (risk ratios, 0.33; 95% confidence interval, 0.24 to 0.43; P=.14). The authors found a statistically significant reduction in blood loss and transfusion rates when using topical tranexamic acid in primary TKA. Furthermore, the currently available evidence does not support an increased risk of deep venous thrombosis or pulmonary embolism due to tranexamic acid administration. Topical tranexamic acid was effective for reducing postoperative blood loss and transfusion requirements without increasing the prevalence of thromboembolic complications.
在初次全膝关节置换术（TKA）中局部使用氨甲环酸的安全性和有效性方面存在诸多争论和争议。本研究的目的是进行一项荟萃分析，以评估在初次TKA中局部应用氨甲环酸后是否有更少的失血和更低的输血率。对电子数据库PubMed、CENTRAL、科学网和Embase进行了系统评价。纳入了所有评估初次TKA期间局部应用氨甲环酸有效性的随机对照试验和前瞻性队列研究。分析的重点是失血结果、输血率和血栓栓塞并发症的结局。尽可能进行亚组分析。在识别出的387项研究中，16项研究（包括1421例患者，1481个膝关节）符合数据提取和荟萃分析的条件。本研究表明，与对照组相比，局部应用氨甲环酸显著减少了总引流量（平均差值，-227.20；95%置信区间，-347.11至-107.30；P<0.00001）、总失血量（平均差值，-311.28；95%置信区间，-404.94至-217.62；P<0.00001）、术后血红蛋白最大降幅（平均差值，-0.73；95%置信区间，-0.96至-0.50；P<0.00001）以及输血需求（风险比，0.33；95%置信区间，0.24至0.43；P = 0.14）。作者发现，在初次TKA中使用局部氨甲环酸时，失血量和输血率有统计学意义的降低。此外，现有证据不支持因应用氨甲环酸而增加深静脉血栓形成或肺栓塞的风险。局部氨甲环酸在不增加血栓栓塞并发症发生率的情况下，对减少术后失血和输血需求有效。
