口服氨甲环酸在初次全膝关节/髋关节置换术中的最佳给药方案：一项随机对照试验的荟萃分析和叙述性综述。

The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial.

机构信息

Department of Orthopedics Medicine, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213000, China.

Department of Respiratory Medicine, The Wujin Clinical college of Xuzhou Medical University, Changzhou, 213000, China.

出版信息

J Orthop Surg Res. 2020 Oct 6;15(1):457. doi: 10.1186/s13018-020-01983-1.

BACKGROUND

Oral tranexamic acid (TXA) has been demonstrated to reduce the blood loss in primary total knee and hip arthroplasty, but the optimal regimen of oral TXA administration is still unknown. This study aimed to find the best number of administrations of oral TXA for primary total knee and hip arthroplasty.

METHODS

The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published before March 20, 2020. Studies clearly reporting a comparison of multiple administrations of oral TXA for total hip/knee replacement were included, and the total blood loss (TBL), intraoperative blood loss (IBL), decline in hemoglobin (DHB), deep vein thrombosis (DVT), intramuscular venous thrombosis (IVT), length of hospital stay (LOS), and transfusion rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed effects or random effects model.

RESULTS

Nine studies involving 1678 patients were included in this meta-analysis (TXA 1363 (one administration, 201; two administrations, 496; three administrations, 215; four administrations, 336; five administrations, 115); placebo 315); the results show that compared with placebo groups, oral TXA could significantly reduce the TBL, IBL, DHB, LOS, and transfusion rate. In addition, the incidences of IVT and DVT were similar between the TXA and placebo groups. Moreover, two administrations of oral TXA significantly reduced the TBL and DHB compared with one administration, three administrations of oral TXA were better than two administrations, and four administrations of oral TXA were better than three administrations.

CONCLUSION

Our results suggested that oral TXA could significantly reduce the blood loss and the length of hospital stay but could not increase the incidence of DVT and IVT for total joint replacement patients; additionally, the effectiveness of oral TXA administration increased as the number of administrations increased.

背景

口服氨甲环酸（TXA）已被证明可减少初次全膝关节和髋关节置换术的失血量，但口服 TXA 的最佳给药方案仍不清楚。本研究旨在确定初次全膝关节和髋关节置换术口服 TXA 的最佳给药次数。

方法

检索 2020 年 3 月 20 日前发表的相关研究，检索PubMed、Embase 和 Cochrane Library 数据库。纳入明确报告比较多次口服 TXA 用于全髋关节/膝关节置换术的研究，并评估总失血量（TBL）、术中失血量（IBL）、血红蛋白下降（DHB）、深静脉血栓形成（DVT）、肌间静脉血栓形成（IVT）、住院时间（LOS）和输血率。使用固定效应或随机效应模型计算加权均数差和相对风险。

结果

本荟萃分析纳入 9 项研究共 1678 例患者（TXA 组 1363 例[一次给药 201 例；两次给药 496 例；三次给药 215 例；四次给药 336 例；五次给药 115 例]；安慰剂组 315 例）。结果显示，与安慰剂组相比，口服 TXA 可显著减少 TBL、IBL、DHB、LOS 和输血率。此外，TXA 组和安慰剂组的 IVT 和 DVT 发生率相似。此外，两次口服 TXA 给药与一次给药相比，显著减少 TBL 和 DHB，三次给药优于两次给药，四次给药优于三次给药。