Ma Qi-Ming, Han Guo-Song, Li Bo-Wen, Li Xiao-Jing, Jiang Ting
Department of Spinal Surgery, The Third Affiliated Hospital of Anhui Medical University, Hefei.
Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
Medicine (Baltimore). 2020 May;99(20):e20214. doi: 10.1097/MD.0000000000020214.
Antifibrinolytic agents have been successfully used to reduce blood transfusion demand in patients undergoing elective knee arthroplasty. The purpose of this study was to investigate different antifibrinolytic agents for patients undergoing total-knee arthroplasty (TKA).
We searched the randomized controlled trials assessing the effect of antifibrinolytic agents on TKA in MEDLINE, PubMed, Embase, and the Cochrane Library. Participants are divided into antifibrinolytic agent group and control group under TKA. Double extraction technology is used and the quality of its methodology is evaluated before analysis. Outcomes analyzed included blood loss, number of blood transfusions, rates of blood transfusion, and deep vein thrombosis (DVT).
A total of 28 randomized controlled trials involving 1899 patients were included in this study. Compared with the control group, the antifibrinolytic agents group exhibited significantly reduced the amounts of total blood loss (weighted mean difference [WMD] with 95% confidence interval [CI]: -272.19, -338.25 to -206.4), postoperative blood loss (WMD with 95% CI: -102.83, -157.64 to -46.02), average units of blood transfusion (risk ratio with 95% CI: 0.7, 0.12 to 0.24), and average blood transfusion volumes (WMD with 95% CI: -1.34, -1.47 to -1,21). Antifibrinolytic agents significantly reduced the rate of blood transfusions and did not increase the occurrence risk of intraoperative blood loss and DVT. Several limitations should also be acknowledged such as the heterogeneity among the studies.
The application of antifibrinolytic agents can significantly reduce blood loss and blood transfusion requirements. Additionally, these agents did not increase the risk of DVT in patients undergoing TKAs.
抗纤溶药物已成功用于减少择期膝关节置换术患者的输血需求。本研究的目的是调查全膝关节置换术（TKA）患者使用不同抗纤溶药物的情况。
我们在MEDLINE、PubMed、Embase和Cochrane图书馆中检索了评估抗纤溶药物对TKA效果的随机对照试验。参与者在TKA下分为抗纤溶药物组和对照组。采用双提取技术，并在分析前评估其方法的质量。分析的结果包括失血量、输血次数、输血率和深静脉血栓形成（DVT）。
本研究共纳入28项涉及1899例患者的随机对照试验。与对照组相比，抗纤溶药物组的总失血量（加权平均差[WMD]，95%置信区间[CI]：-272.19，-338.25至-206.4）、术后失血量（WMD，95%CI：-102.83，-157.64至-46.02）、平均输血量（风险比，95%CI：0.7，0.12至0.24）和平均输血量（WMD，95%CI：-1.34，-1.47至-1.21）均显著减少。抗纤溶药物显著降低了输血率，且未增加术中失血和DVT的发生风险。还应承认一些局限性，如研究之间的异质性。
抗纤溶药物的应用可显著减少失血量和输血需求。此外，这些药物不会增加TKA患者发生DVT的风险。
