Fu Yu, Shi Zhigang, Han Bing, Ye Yong, You Tao, Jing Juehua, Li Jun
Department of Orthopaedics, The Second Hospital of Anhui Medical University Department of Orthopaedics, The First Hospital of Anhui Medical University, Hefei, Anhui, PR China.
Medicine (Baltimore). 2016 Dec;95(50):e5583. doi: 10.1097/MD.0000000000005583.
The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) were to gather data to evaluate the efficacy and safety of topical tranexamic acid (TXA) versus intravenous (IV) TXA for blood loss after a total knee arthroplasty (TKA).
Electronic databases: Pubmed, Web of Science, Cochrane library, and Embase from inception to June 2016 were searched. RCTs that comparing topical with IV TXA for blood loss control in patients prepared for TKA were included in this meta-analysis. The Cochrane risk of bias tool was used to appraise risk of bias. The primary outcomes were needed for transfusion, total blood loss, and blood loss in drainage. Secondary outcomes are hemoglobin (Hb) value at 24-hour post TKA and complication (deep venous thrombosis [DVT] and infection). The efficacy of blood loss was tested by total blood loss, drainage volume, Hb drop, and the Hb value at 24 hours after TKA. The safety was measured by the occurrence of DVT and infection. Continuous outcomes were expressed as the mean difference with the respective 95% confidence intervals (CIs). Discontinuous outcomes were expressed as the relative risk with 95% CIs. Stata 12.0 software (Stata Corp., College Station, TX) was used for the meta-analysis.
A total of 14 articles involving 1390 patients were finally included for this meta-analysis. The pooled results revealed that there were no significant difference between the need for transfusion, total blood loss, blood loss in drainage, Hb value at 24-hour post TKA, the occurrence of complications (infection and DVT) between topical administration of TXA and IV TXA.
Topical TXA has similar efficacy for blood loss control to IV TXA without sacrificing safety in TKA. However, the dose of topical TXA and IV TXA is different, thus, optimal timing and dose of TXA are still needed to explore the maximum effect of TXA.
本随机对照试验（RCT）的系统评价和荟萃分析旨在收集数据，以评估局部应用氨甲环酸（TXA）与静脉注射（IV）TXA对全膝关节置换术（TKA）后失血的疗效和安全性。
检索电子数据库：从创刊至2016年6月的Pubmed、科学网、Cochrane图书馆和Embase。本荟萃分析纳入了比较局部应用与静脉注射TXA对准备接受TKA患者控制失血情况的RCT。采用Cochrane偏倚风险工具评估偏倚风险。主要结局指标为输血需求、总失血量和引流液失血量。次要结局指标为TKA术后24小时的血红蛋白（Hb）值和并发症（深静脉血栓形成[DVT]和感染）。通过总失血量、引流液量、Hb下降情况以及TKA术后24小时的Hb值来检验失血的疗效。通过DVT和感染的发生率来衡量安全性。连续结局指标以均值差异及各自的95%置信区间（CI）表示。非连续结局指标以相对风险及95%CI表示。采用Stata 12.0软件（Stata公司，德克萨斯州大学站）进行荟萃分析。
本荟萃分析最终共纳入14篇文章，涉及1390例患者。汇总结果显示，局部应用TXA与静脉注射TXA在输血需求、总失血量、引流液失血量、TKA术后24小时的Hb值、并发症（感染和DVT）发生率方面无显著差异。
在TKA中，局部应用TXA在控制失血方面与静脉注射TXA具有相似的疗效，且不影响安全性。然而，局部应用TXA和静脉注射TXA的剂量不同，因此，仍需要探索TXA的最佳使用时机和剂量，以发挥其最大效果。
