Laboratory for New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Traumatology & Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China.
Medicine (Baltimore). 2021 Mar 26;100(12):e25087. doi: 10.1097/MD.0000000000025087.
Topical hemostatic agents are commonly used for reducing perioperative blood loss and transfusion requirement in primary total knee arthroplasty (TKA), although the optimal option has yet to be defined. This study aimed to evaluate the efficacy and safety of topical hemostatic agents and rank the best intervention using the network meta-analysis (NMA) method.
We searched Web of science, PubMed, and Cochrane Library database up to April 2020, for randomized controlled trials (RCTs) on topical hemostatic agents in primary TKA. The quality of included studies was assessed using the Cochrane "risk of bias" tool. Direct and indirect comparisons were performed for the result of network meta-analysis followed by consistency test.
Thirty seven RCTs with 3792 patients were included in this NMA and the pooled results indicated that tranexamic acid plus diluted epinephrine (TXA+DEP) displayed the highest efficacy in reducing total blood loss, hemoglobin drop and transfusion requirement. None of the included treatments was found to increase risk of thromboembolic events compared to placebo. According to the results of ranking probabilities, TXA+DEP had the highest possibility to be the best topical hemostatic agent with regard to the greatest comparative efficacy and a relatively high safety level.
Current evidence supports that administration of TXA+DEP may be the optimal topical hemostatic agent to decrease blood loss and transfusion requirement in primary TKA. More direct studies that focused on the topical application of TXA+DEP versus other treatments are needed in the future.
在初次全膝关节置换术（TKA）中，局部止血剂通常被用于减少围手术期的失血量和输血需求，尽管尚未确定最佳选择。本研究旨在通过网络荟萃分析（NMA）方法评估局部止血剂的疗效和安全性，并对最佳干预措施进行排名。
我们检索了 Web of science、PubMed 和 Cochrane Library 数据库，截至 2020 年 4 月，检索了关于初次 TKA 中局部止血剂的随机对照试验（RCT）。使用 Cochrane“偏倚风险”工具评估纳入研究的质量。对网络荟萃分析的结果进行直接和间接比较，并进行一致性检验。
这项 NMA 共纳入 37 项 RCT 共计 3792 例患者，汇总结果表明，氨甲环酸加稀释肾上腺素（TXA+DEP）在减少总失血量、血红蛋白下降和输血需求方面效果最佳。与安慰剂相比，任何一种治疗方法均未发现增加血栓栓塞事件的风险。根据排名概率的结果，TXA+DEP 最有可能成为最佳局部止血剂，因为它具有最大的比较疗效和相对较高的安全性。
目前的证据支持在初次 TKA 中使用 TXA+DEP 可能是减少失血量和输血需求的最佳局部止血剂。未来需要更多直接针对 TXA+DEP 与其他治疗方法的局部应用的研究。
