Chen Xuanhuang, Zheng Feng, Zheng Zugao, Wu Xianwei, Wu Changfu
Department of Orthopedics, The Affiliated Hospital of Putian University, Putian, Fujian, China.
Medicine (Baltimore). 2019 May;98(20):e15248. doi: 10.1097/MD.0000000000015248.
This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA).
PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables.
A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = -0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54-1.13, P = .19), total blood loss (MD = 16.31, 95% CI = -69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = -12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = -0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = -15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = -0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = -0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality.
Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.
本研究旨在比较口服氨甲环酸（TXA）与静脉注射TXA在全膝关节置换术（TKA）和全髋关节置换术（THA）中减少围手术期失血的疗效和安全性。
全面检索PubMed、科学网、Embase和Cochrane图书馆以查找相关研究。本研究纳入了比较口服TXA与静脉注射TXA在TKA和THA中的疗效和安全性的研究。采用比值比（OR）或风险差异（RD）比较二分变量，而采用均值差异（MD）比较连续变量。
本研究共纳入7项研究（5项随机对照试验和2项回顾性研究）。对于接受TKA或THA的患者，口服TXA组和静脉注射TXA组在血红蛋白（Hb）下降（MD = 0.06，95%置信区间[CI] = -0.01至0.13，P = 0.09）、输血率（OR = 0.78，95% CI = 0.54 - 1.13，P = 0.19）、总失血量（MD = 16.31，95% CI = -69.85至102.46，P = 0.71）、总Hb丢失量（MD = 5.18，95% CI = -12.65至23.02，P = 0.57）、住院时间（MD = -0.06，95% CI = -0.30至0.18，P = 0.63）、引流量（MD = 21.04，95% CI = -15.81至57.88，P = 0.26）、深静脉血栓形成发生率（RD = 0.00，95% CI = -0.01至0.01，P = 0.82）或肺栓塞发生率（RD = 0.00，95% CI = -0.01至0.01，P = 0.91）方面均无明显差异。本研究的样本量较小，且纳入的几项研究质量相对较低。
口服TXA在减少围手术期失血方面与静脉注射TXA相当，应在TKA和THA中推荐使用。需要更多高质量的研究来阐明这一问题。
