Baskaran Dinnish, Rahman Syed, Salmasi Yousuf, Froghi Saied, Berber Onur, George Marc
1 Colchester Hospital University NHS Foundation Trust, Colchester - UK.
2 Luton and Dunstable University Hospital, Luton - UK.
Hip Int. 2018 Jan;28(1):3-10. doi: 10.5301/hipint.5000556.
Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence.
A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events.
8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00001), reduced operative blood loss of 88.5 mls (95% CI, 59.9-117.2; p<0.00001), a decrease in the need for allogenic blood transfusion (OR 0.37; 95% CI, 0.26-0.53; p<0.00001) and a reduction in pre- and postoperative haemoglobin difference (p = 0.013.) There was no significant increase in VTE risk (OR 1.59; 95% CI 0.67-3.75; p>0.29) or significant difference on duration of surgery seen with IV TXA usage (p>0.06).
Our review demonstrated the efficacy of IV TXA in minimising perioperative, reducing total blood loss and lowering the necessity for allogenic blood transfusions with no significant increased risk in VTE events.
静脉注射氨甲环酸（IV TXA）是一种公认的药物干预措施，用于减少失血和异体输血。然而，IV TXA在髋部骨折手术中的应用仍无定论。我们进行了一项荟萃分析，以研究TXA在髋部骨折手术治疗中对术中及总失血量、异体输血需求以及对静脉血栓栓塞（VTE）事件发生率的影响。
对PubMed、Medline、Embase、Ovid、Cochrane对照试验注册库、Trip和谷歌进行了系统的计算机文献检索。我们回顾了IV TXA对围手术期失血量、总失血量、术前和术后血红蛋白差异、手术时间、异体输血需求和VTE事件的疗效。
8项研究符合条件，包括6项随机对照试验和2项队列研究。接受IV TXA的患者平均总失血量减少442.9毫升（95%置信区间，426.5 - 459.3；p < 0.00001），术中失血量减少88.5毫升（95%置信区间，59.9 - 117.2；p < 0.00001），异体输血需求减少（比值比0.37；95%置信区间，0.26 - 0.53；p < 0.00001），术前和术后血红蛋白差异减小（p = 0.013）。VTE风险没有显著增加（比值比1.59；95%置信区间0.67 - 3.75；p > 0.29），使用IV TXA对手术时间也没有显著差异（p > 0.06）。
我们的综述表明，IV TXA在减少围手术期失血、降低总失血量以及降低异体输血必要性方面有效，且VTE事件风险没有显著增加。
