Tian Peng, Liu Wen-Bin, Li Zhi-Jun, Xu Gui-Jun, Huang Yu-Ting, Ma Xin-Long
Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China.
Department of Joint Surgery, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China.
BMC Musculoskelet Disord. 2017 Jun 21;18(1):273. doi: 10.1186/s12891-017-1633-y.
There is no consistent conclusion regarding the efficacy and safety of the intravenous administration of tranexamic acid (TXA) for reducing blood loss in revision total knee arthroplasty (TKA). We performed a meta-analysis of comparative trials to evaluate the efficacy and safety of TXA in revision TKA.
We conducted a search of PubMed, EMBASE, The Cochrane Library and Web of Science for randomized controlled trials (RCTs) and non-RCTs. Two authors selected the studies, extracted the data, and assessed the risk of bias independently. A pooled meta-analysis was performed using RevMan 5.3 software.
Four non-RCTs met the inclusion criteria. The meta-analysis indicated that the use of TXA was related to significantly less transfusion requirements (RD = -0.25; 95% CI: -0.43 to -0.08; P = 0.005), drainage volume (MD = -321.07; 95% CI: -445.13 to -197.01, P = 0.005), hemoglobin reduction (MD = -0.52; 95% CI: -0.79 to -0.25, P = 0.0001), and length of hospital stay (MD = -2.36; 95% CI: -4.00 to -0.71, P = 0.005). No significant differences in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were noted.
The use of TXA for patients undergoing revision TKA may reduce blood loss and transfusion requirements without increasing the risk of postoperative venous thromboembolism. Due to the limited quality of the currently available evidence, more high-quality RCTs are required.
关于在翻修全膝关节置换术（TKA）中静脉注射氨甲环酸（TXA）减少失血的有效性和安全性，尚无一致结论。我们进行了一项比较试验的荟萃分析，以评估TXA在翻修TKA中的有效性和安全性。
我们在PubMed、EMBASE、Cochrane图书馆和科学网中检索随机对照试验（RCT）和非RCT。两位作者独立选择研究、提取数据并评估偏倚风险。使用RevMan 5.3软件进行汇总荟萃分析。
四项非RCT符合纳入标准。荟萃分析表明，使用TXA与显著减少输血需求（RD = -0.25；95%CI：-0.43至-0.08；P = 0.005）、引流量（MD = -321.07；95%CI：-445.13至-197.01，P = 0.005）、血红蛋白降低（MD = -0.52；95%CI：-0.79至-0.25，P = 0.0001）和住院时间（MD = -2.36；95%CI：-4.00至-0.71，P = 0.005）相关。深静脉血栓形成（DVT）或肺栓塞（PE）的发生率无显著差异。
在接受翻修TKA的患者中使用TXA可能减少失血和输血需求，而不会增加术后静脉血栓栓塞的风险。由于现有证据质量有限，需要更多高质量的RCT。
