Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Orthop Surg Res. 2020 Dec 2;15(1):581. doi: 10.1186/s13018-020-02119-1.
The optimal dosage and administration approach of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains controversial. In light of recently published 14 randomized controlled trials (RCTs), the study aims to incorporate the newly found evidence and compare the efficacy and safety of intra-articular (IA) vs. intravenous (IV) application of TXA in primary TKA.
PubMed, Embase, Web of Science, and Cochrane Library were searched for RCTs comparing IA with IV TXA for primary TKA. Primary outcomes included total blood loss (TBL) and drain output. Secondary outcomes included hidden blood loss (HBL), hemoglobin (Hb) fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time.
In all, 34 RCTs involving 3867 patients were included in our meta-analysis. Significant advantages of IA were shown on TBL (MD = 33.38, 95% CI = 19.24 to 47.51, P < 0.001), drain output (MD = 28.44, 95% CI = 2.61 to 54.27, P = 0.03), and postoperative day (POD) 3+ Hb fall (MD = 0.24, 95% CI = 0.09 to 0.39, P = 0.001) compared with IV. There existed no significant difference on HBL, POD1 and POD2 Hb fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time between IA and IV.
Intra-articular administration of TXA is superior to intravenous in primary TKA patients regarding the performance on TBL, drain output, and POD3+ Hb fall, without increased risk of perioperative complications. Therefore, intra-articular administration is the recommended approach in clinical practice for primary TKA.
氨甲环酸（TXA）在初次全膝关节置换术（TKA）中的最佳剂量和给药途径仍存在争议。鉴于最近发表的 14 项随机对照试验（RCT），本研究旨在纳入新发现的证据，并比较初次 TKA 中关节内（IA）与静脉内（IV）应用 TXA 的疗效和安全性。
检索 PubMed、Embase、Web of Science 和 Cochrane Library，比较初次 TKA 中 IA 与 IV TXA 的 RCT。主要结局包括总失血量（TBL）和引流量。次要结局包括隐性失血量（HBL）、血红蛋白（Hb）下降、输血率、围手术期并发症、住院时间和止血带时间。
共有 34 项 RCT 纳入了 3867 例患者，纳入我们的荟萃分析。IA 在 TBL（MD=33.38，95%CI=19.24 至 47.51，P<0.001）、引流量（MD=28.44，95%CI=2.61 至 54.27，P=0.03）和术后第 3 天+Hb 下降（MD=0.24，95%CI=0.09 至 0.39，P=0.001）方面具有显著优势。IA 与 IV 在 HBL、术后第 1 天和第 2 天的 Hb 下降、输血率、围手术期并发症、住院时间和止血带时间方面无显著差异。
初次 TKA 患者关节内应用 TXA 在 TBL、引流量和术后第 3 天+Hb 下降方面优于静脉内应用，且不增加围手术期并发症风险。因此，关节内应用是初次 TKA 临床实践中的推荐方法。
