Yuan Z F, Yin H, Ma W P, Xing D L
Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No.67 Dongchang Road, Liaocheng, Shandong 252000, China.
Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No.67 Dongchang Road, Liaocheng, Shandong 252000, China
Bone Joint Res. 2016 Aug;5(8):353-61. doi: 10.1302/2046-3758.58.BJR-2016-0001.R2.
Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA.
A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.
A total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group.
Compared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA.Cite this article: Z. F. Yuan, H. Yin, W. P. Ma, D. L. Xing. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016;5:353-361. DOI: 10.1302/2046-3758.58.BJR-2016-0001.R2.
氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，在全膝关节置换术（TKA）中用作血液保护技术，通常通过静脉注射（IV）或关节内注射（IA）给药。最近，一种新的TXA给药方法，即TXA的静脉和关节内联合应用，已应用于TKA。然而，TKA中TXA联合给药的科学证据仍然不足。本荟萃分析旨在研究TKA患者中静脉和关节内联合应用TXA的有效性和安全性。
在PubMed、Cochrane临床试验注册库（2015年第12期）、Embase、科学网和中国生物医学数据库中进行了系统检索。仅纳入评估TKA中联合使用TXA的有效性和安全性的随机对照试验（RCT）。两位作者独立识别符合条件的研究，提取数据并评估纳入研究的方法学质量。使用Review Manager 5.3软件进行荟萃分析。
本研究共纳入10项RCT（1143例患者）。所有纳入研究均为随机研究，纳入研究的质量仍需提高。结果表明，与安慰剂组或单剂量TXA（静脉或关节内）组相比，静脉和关节内联合应用TXA组的总失血量、隐性失血量、总引流量显著减少，输血率降低，血红蛋白水平下降幅度较小。联合组与安慰剂组或单剂量TXA组在伤口感染和深静脉血栓形成等并发症方面无统计学显著差异。
与安慰剂或单剂量TXA相比，静脉和关节内联合应用TXA在所有与术后失血相关的结局方面均取得了显著更好的效果，且未增加TKA中血栓栓塞并发症的风险。引用本文：袁志峰，尹华，马文鹏，邢德亮。静脉和局部应用氨甲环酸对全膝关节置换术中失血和输血率的联合影响：全膝关节置换术联合氨甲环酸。骨关节研究2016；5：353 - 361。DOI：10.1302/2046 - 3758.58.BJR - 2016 - 0001.R2。
