Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba; Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba; Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba.
Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
Transfus Med Rev. 2020 Jan;34(1):51-62. doi: 10.1016/j.tmrv.2019.10.001. Epub 2019 Oct 23.
Tranexamic acid (TXA) reduces transfusion requirements in cardiac surgery and total hip and knee arthroplasty, where it has become standard of care. Our objective is to determine the efficacy and safety of TXA in other surgeries associated with a high risk for red blood cell (RBC) transfusion. We identified randomized controlled trials in Medline, Embase, CENTRAL, and CAB abstracts from inception to June 2019. We included trials evaluating intraoperative IV TXA in adult patients undergoing a non-cardiac and non-hip and knee arthroplasty surgeries at high-risk for RBC transfusion, defined as a baseline transfusion rate ≥5% in comparator arm. We assessed risk of bias using the Cochrane Risk of Bias tool. We used GRADE methodology to assess certainty of evidence. From 8565 citations identified, we included 69 unique trials, enrolling 6157 patients. TXA reduces both the proportion of patients transfused RBCs (relative risk (RR) 0.59; 95% confidence interval (CI) 0.48 to 0.72; low certainty evidence) and the volume of RBC transfused (MD -0.51 RBC units; 95%CI -0.13 to -0.9 units; low certainty evidence) when compared to placebo or usual care. TXA was not associated with differences in deep vein thrombosis, pulmonary embolism, all-cause mortality, hospital length of stay, need for re-operation due to hemorrhage, myocardial infarction, stroke or seizure. In patients undergoing a broad range of non-cardiac and non-hip and knee arthroplasty surgeries at high risk for RBC transfusion, perioperative TXA reduced exposure to RBC transfusion. No differences in thrombotic outcomes were identified; however, summary effect estimates were limited by lack of systemic screening and short duration of follow-up.
氨甲环酸（TXA）可减少心脏手术、全髋关节和全膝关节置换术的输血需求，已成为此类手术的常规治疗方法。我们的目标是确定 TXA 在其他输血风险较高的手术中的疗效和安全性。我们在 Medline、Embase、CENTRAL 和 CAB 摘要中检索了从建库至 2019 年 6 月的随机对照试验。我们纳入了评估术中静脉内给予 TXA 的成年患者的试验，这些患者接受非心脏和非髋关节或膝关节置换术，输血风险较高，定义为对照组输血率基线≥5%。我们使用 Cochrane 偏倚风险工具评估偏倚风险。我们使用 GRADE 方法评估证据确定性。从 8565 条引用中，我们纳入了 69 项独特的试验，共纳入 6157 名患者。与安慰剂或常规治疗相比，TXA 可降低输血患者的比例（相对风险（RR）0.59；95%置信区间（CI）0.48 至 0.72；低确定性证据）和输血量（MD-0.51 个 RBC 单位；95%CI-0.13 至-0.9 单位；低确定性证据）。TXA 与深静脉血栓形成、肺栓塞、全因死亡率、住院时间、因出血再次手术、心肌梗死、卒中和癫痫无差异。在输血风险较高的广泛非心脏和非髋关节或膝关节置换术患者中，围手术期 TXA 可减少 RBC 输血。血栓形成结局无差异；然而，由于缺乏系统筛查和随访时间短，汇总效应估计值受限。
