Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China; Tianjin University of Traditional Chinese Medicine, 300193, People's Republic of China.
Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
Int J Surg. 2017 Sep;45:77-84. doi: 10.1016/j.ijsu.2017.07.097. Epub 2017 Jul 26.
Tranexamic acid (TXA) is regarded as one of the most important drugs in reducing blood loss and hemoglobin (Hb) drop after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Treatment with tranexamic acid (TXA) by intravenous application has been discussed extensively. Recently, several studies have reported that oral administration has an effect on blood sparing. Therefore, we performed a meta-analysis to investigate the efficacy and safety between oral TXA and intravenous TXA (IV-TXA) for blood sparing in total knee and hip arthroplasty.
Randomized controlled trials (RCTs) or retrospective cohort studies (RCSs) about relevant research were searched for by using PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Five studies that compared oral with IV administration of TXA were included in our meta-analysis. Meta-analysis results were collected and analyzed by the software Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center, The Collaboration, 2014).
Five studies containing 3474 patients met the inclusion criteria. Our pooled data analysis indicated that oral TXA was as effective as the IV-TXA in terms of the average Hb drop (P = 0.88), total Hb loss (P = 0.57), total blood loss (P = 0.42), transfusion rate (P = 0.16), complications (P = 0.61), and length of hospital stay (P = 1.00).
Compared with the IV-TXA method, oral TXA shows similar blood-sparing efficacy for preventing hemoglobin drop, total hemoglobin loss, and total blood loss following TKA or THA. In addition, no significant differences of transfusion rate, complications, or length of hospital stay were found between the 2 groups. However, because of the limited number of included studies, more studies of high quality are needed to further identify the optimal administration time for oral TXA.
氨甲环酸（TXA）被认为是减少全膝关节置换术（TKA）或全髋关节置换术（THA）后失血和血红蛋白（Hb）下降的最重要药物之一。静脉应用氨甲环酸（TXA）的治疗已被广泛讨论。最近，有几项研究报道口服给药对血液保存有作用。因此，我们进行了一项荟萃分析，以调查口服 TXA 和静脉内 TXA（IV-TXA）在全膝关节和髋关节置换术中血液保存方面的疗效和安全性。
通过使用 PubMed（1996 年-2017 年 4 月）、Embase（1980 年-2017 年 4 月）和 Cochrane 图书馆（CENTRAL，2017 年 4 月）搜索了有关该研究的随机对照试验（RCTs）或回顾性队列研究（RCSs）。我们的荟萃分析纳入了比较口服与 IV 给予 TXA 的五项研究。使用 Review Manager 5.3 软件（哥本哈根：北欧 Cochrane 中心，协作组，2014 年）收集和分析荟萃分析结果。
五项研究共纳入 3474 例患者符合纳入标准。我们的汇总数据分析表明，在平均 Hb 下降（P=0.88）、总 Hb 损失（P=0.57）、总失血（P=0.42）、输血率（P=0.16）、并发症（P=0.61）和住院时间（P=1.00）方面，口服 TXA 与 IV-TXA 同样有效。
与 IV-TXA 方法相比，口服 TXA 在预防 TKA 或 THA 后血红蛋白下降、总血红蛋白丢失和总失血方面显示出相似的血液节约效果。此外，两组之间输血率、并发症或住院时间无显著差异。然而，由于纳入研究的数量有限，需要更多高质量的研究来进一步确定口服 TXA 的最佳给药时间。
