Gong Min, Liu Guoming, Chen Li, Chen Ran, Xiang Zhou
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
World Neurosurg. 2019 Feb;122:559-568. doi: 10.1016/j.wneu.2018.09.115. Epub 2018 Oct 16.
To evaluate the efficacy and safety of tranexamic acid (TXA), we conducted a systematic review and meta-analysis of studies on intravenous TXA in posterior lumbar interbody fusion (PLIF) in adults.
We searched databases, including PubMed, EMBASE, and the Cochrane Library. The included articles, limited to English, compared intravenous TXA with placebo in adults who underwent PLIF. The methodologic quality of the studies was assessed using the following parameters: heterogeneity, weighted mean difference (WMD), relative risk, 95% confidence interval (CI), and subgroup analysis.
Seven studies (5 randomized controlled trials and 2 nonrandomized controlled trials) were included in which 529 patients were treated by PLIF. We found that intravenous TXA can reduce total blood loss (WMD = -172.04, 95% confidence interval [CI] -204.70 to -139.37), intraoperative blood loss (WMD = -83.10, 95% CI -117.61 to -48.60), and postoperative blood loss (WMD = -83.10, 95% CI -117.61 to -48.60) but cannot reduce the blood transfusion rates (relative risk = 0.39; 95% CI 0.21-0.72). High-dose TXA could more effectively reduce the blood loss than the low-dose TXA. The risk of thrombotic events was not observed.
This meta-analysis showed that intravenous TXA can significantly reduce surgical blood loss and patients treated with TXA did not have a significant decrease in transfusion rates. Furthermore, it is safe and does not increase the risk of thrombotic events. We recommend intravenous TXA and the use of high-dose TXA during PLIF in adults. However, more high-quality and large-sample studies will be needed to confirm this result.
为评估氨甲环酸（TXA）的疗效及安全性，我们对关于成人后路腰椎椎间融合术（PLIF）中静脉注射TXA的研究进行了系统评价和荟萃分析。
我们检索了包括PubMed、EMBASE和Cochrane图书馆在内的数据库。纳入的文章仅限于英文，比较了成人PLIF术中静脉注射TXA与安慰剂的效果。使用以下参数评估研究的方法学质量：异质性、加权平均差（WMD）、相对风险、95%置信区间（CI）和亚组分析。
纳入了7项研究（5项随机对照试验和2项非随机对照试验），其中529例患者接受了PLIF治疗。我们发现静脉注射TXA可减少总失血量（WMD = -172.04，95%置信区间[CI] -204.70至-139.37）、术中失血量（WMD = -83.10，95% CI -117.61至-48.60）和术后失血量（WMD = -83.10，95% CI -117.61至-48.60），但不能降低输血率（相对风险 = 0.39；95% CI 0.21 - 0.72）。高剂量TXA比低剂量TXA能更有效地减少失血量。未观察到血栓形成事件的风险。
这项荟萃分析表明，静脉注射TXA可显著减少手术失血量，且接受TXA治疗的患者输血率没有显著降低。此外，它是安全的，不会增加血栓形成事件的风险。我们建议在成人PLIF术中静脉注射TXA并使用高剂量TXA。然而，需要更多高质量、大样本的研究来证实这一结果。
