Wang Mian, Tan Hongzhuan, Wu Zhaozhao, Liang Ying
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University Hunan Center for Drug Evaluation Certification & ADR Monitoring, Hunan, China.
Medicine (Baltimore). 2018 Aug;97(34):e11967. doi: 10.1097/MD.0000000000011967.
Blood management after peri-acetabular osteotomy (PAO) has become a serious problem. We performed a meta-analysis to evaluate the efficacy and safety of antifibrinolytics for blood management after PAO.
PubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to January, 2018 without restrictions on publication date and language. We also searched the relevant publication sources. The research was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Randomized controlled trials (RCTs) and non-RCTs were included in our study. Weighted mean differences, risk difference, and 95% confidence intervals were calculated. We assessed statistical heterogeneity for each outcome with the use of a standard chi-square test and I statistic. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Primary outcomes were total blood loss, postoperative hemoglobin decline, and transfusion rates. Secondary outcomes were length of a hospital stay and postoperative complications.
Four studies including 1 RCT and 3 non-RCTs were included in our study. The present meta-analysis indicated that antifibrinolytics was associated with a significant reduction of the total blood loss, postoperative hemoglobin decline, transfusion rates, and length of a hospital stay compared with control groups. No significant differences were identified in terms of the incidence of postoperative complications.
Intravenous antifibrinolytics was efficacious in reduction of total blood loss, postoperative hemoglobin decline, and length of a hospital stay after PAO without increasing the risk of thromboembolic complications. More high-quality RCTs with long follow-up period were necessary for proper comparisons of the efficacy and safety of antifibrinolytics with placebo.
髋臼周围截骨术（PAO）后的血液管理已成为一个严重问题。我们进行了一项荟萃分析，以评估抗纤溶药物在PAO后血液管理中的有效性和安全性。
检索了截至2018年1月的PubMed、OVID、Embase、ScienceDirect和Web of Science，对出版日期和语言无限制。我们还检索了相关的出版来源。该研究按照系统评价和荟萃分析的首选报告项目指南进行报告。我们的研究纳入了随机对照试验（RCT）和非RCT。计算加权平均差、风险差和95%置信区间。我们使用标准的卡方检验和I统计量评估每个结局的统计异质性。数据由两位共同作者独立提取，并使用RevMan5.3进行分析。主要结局为总失血量、术后血红蛋白下降和输血率。次要结局为住院时间和术后并发症。
我们的研究纳入了4项研究，包括1项RCT和3项非RCT。目前的荟萃分析表明，与对照组相比，抗纤溶药物可显著减少总失血量、术后血红蛋白下降、输血率和住院时间。在术后并发症发生率方面未发现显著差异。
静脉注射抗纤溶药物在减少PAO后的总失血量、术后血红蛋白下降和住院时间方面有效，且不会增加血栓栓塞并发症的风险。为了将抗纤溶药物与安慰剂的有效性和安全性进行适当比较，需要更多高质量、长期随访的RCT。
