Ling Tao, Zhao Zhihu, Xu Wenwen, Ge Weihong, Huang Lingli
Department of Pharmacy, Suqian First Hospital, Suqian, China.
Department of Orthopaedics, Tianjin Hospital, Tianjin, China.
Front Pharmacol. 2021 Jul 21;12:639694. doi: 10.3389/fphar.2021.639694. eCollection 2021.
Total knee arthroplasty (TKA) surgery has a lot of complications, especially hemorrhage, which can be controlled tranexamic acid (TXA). The guidelines endorse the integration of TXA interventions in the management of TKA-induced complications. However, uncertainty surrounds the effects of different TXA therapies. This frequentist model network meta-analysis (NMA) aims to compare hemorrhage control and deep venous thrombosis (DVT) rate of different TXA therapies in TKA. Articles were searched with the PubMed, Embase, Cochrane Library, and Web of Science from 1966 to October 2020. Randomized controlled trials (RCTs) comparing different TXA therapies, or with placebo in patients with TKA were included. Two investigators independently conducted article retrievals and data collection. The outcome was total blood loss and DVT rate. Effect size measures were mean differences (MDs), or odds ratios (ORs) with 95% confidence intervals (CIs). We conducted a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses were performed in Stata software or R software. The study protocol was registered with PROSPERO, number CRD42020202404. We identified 1 754 citations and included 81 studies with data for 9 987 patients with TKA. Overall, all TXA therapies were superior to placebo for total blood loss in TKA. Of all TXA therapies, M therapy (IV/IV infusion + oral TXA > 3g) was most effective for total blood loss (MD=-688.48, -1084.04--328.93), followed by F therapy (IV TXA ≥ 15 mg/kg or 1 g three times). TXA therapies in this study are not associated with the increase of DVT risk. TXA therapies in this study are effective and safe for the treatment of TKA-induced complications. M therapy (IV/IV infusion + oral TXA > 3 g) may be the most effective TXA therapy for hemorrhage control. TXA therapies in this study do not increase DVT risk. Considering hemorrhage control and DVT rate simultaneously, F therapy (IV TXA ≥ 15 mg/kg or 1 g three times) may be suggested to apply for TKA, and this study may provide a crucial clue to future TXA use.
全膝关节置换术（TKA）手术有许多并发症，尤其是出血，而氨甲环酸（TXA）可以控制出血。指南支持将TXA干预措施纳入TKA所致并发症的管理中。然而，不同TXA疗法的效果仍存在不确定性。这项频率学派模型网络荟萃分析（NMA）旨在比较不同TXA疗法在TKA中控制出血和深静脉血栓形成（DVT）的发生率。我们在PubMed、Embase、Cochrane图书馆和Web of Science数据库中检索了1966年至2020年10月期间的文献。纳入了比较不同TXA疗法或TKA患者使用TXA与安慰剂对照的随机对照试验（RCT）。两名研究人员独立进行文献检索和数据收集。观察指标为总失血量和DVT发生率。效应量测量指标为平均差（MDs）或比值比（ORs）及其95%置信区间（CIs）。我们采用频率学派方法进行随机效应NMA，以估计所有比较的相对效应，并根据平均秩和累积排序曲线下面积值对治疗进行排序。所有分析均在Stata软件或R软件中进行。该研究方案已在国际前瞻性注册系统（PROSPERO）注册，注册号为CRD42020202404。我们共识别出1754条引文，纳入了81项研究，涉及9987例TKA患者的数据。总体而言，在TKA中，所有TXA疗法在控制总失血量方面均优于安慰剂。在所有TXA疗法中，M疗法（静脉/静脉输注+口服TXA>3g）在控制总失血量方面最有效（MD=-688.48，-1084.04--328.93），其次是F疗法（静脉注射TXA≥15mg/kg或1g，每日三次）。本研究中的TXA疗法与DVT风险增加无关。本研究中的TXA疗法在治疗TKA所致并发症方面有效且安全。M疗法（静脉/静脉输注+口服TXA>3g）可能是控制出血最有效的TXA疗法。本研究中的TXA疗法不会增加DVT风险。同时考虑出血控制和DVT发生率，建议F疗法（静脉注射TXA≥15mg/kg或1g，每日三次）应用于TKA，本研究可能为未来TXA的使用提供关键线索。
Zotero 插件
