Evangelismos General Hospital, Orthopaedic Department, Athens, Greece.
Konstandopoulio General Hospital, 2nd Academic Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece.
Injury. 2022 Feb;53(2):294-300. doi: 10.1016/j.injury.2021.09.063. Epub 2021 Oct 12.
The objective of this study was to assess the efficacy and safety of intravenous TXA administration in elderly patients undergoing hip fracture surgery focusing on the effect of various dosages.
A systematic search of PubMed, Embase and Cochrane Library was conducted until February 2021. Our primary outcome was peri‑operative total blood loss, while secondary outcomes included transfusion rate, mean count of transfused RBC units and thromboembolic events' incidence. A subgroup analysis was performed with respect to TXA dosage.
Out of 146 records identified, 10 randomized controlled studies met the selection criteria. Data synthesis revealed that TXA resulted in a significant reduction in total blood loss by 229.45 ml in favor of TXA; 95% CI: [189.5, 269.4] and transfusion rate by 40%, RR = 0.60; 95% CI: [0.47, 0.78]. No increase in thromboembolic events rate was observed (RR = 1.08, 95% CI: [0.68, 1.69]) Furthermore, sub-analysis with respect to TXA dosage showed no significant difference in total blood loss reduction between "single" and "multiple doses" studies (223 vs 233.5 ml, p = 0.85.), while a trend for lower complications rate was observed in patients receiving a single dose of ≤ 15 mg/kg.
This meta-analysis provides strong evidence that TXA is a safe and effective agent to reduce perioperative blood loss in hip fracture surgery. When compared with higher dosages, a single dose of 15 mg/kg is associated with a non-significant reduction in adverse events, while achieving comparable outcomes.
本研究旨在评估静脉注射氨甲环酸（TXA）在老年髋部骨折手术患者中的疗效和安全性，重点关注不同剂量的效果。
系统检索 PubMed、Embase 和 Cochrane Library 数据库，检索时间截至 2021 年 2 月。主要结局指标为围手术期总失血量，次要结局指标包括输血率、输红细胞单位的平均数量和血栓栓塞事件发生率。进行了 TXA 剂量的亚组分析。
在纳入的 146 篇记录中，有 10 项随机对照研究符合入选标准。数据综合结果表明，TXA 可显著减少总失血量，有利于 TXA 的组为 229.45ml；95%置信区间：[189.5，269.4]；输血率降低 40%，RR=0.60；95%置信区间：[0.47，0.78]。未观察到血栓栓塞事件发生率增加（RR=1.08，95%置信区间：[0.68，1.69]）。此外，根据 TXA 剂量的亚组分析，在“单次”和“多次”剂量研究中，总失血量减少无显著差异（223 与 233.5ml，p=0.85），但单次剂量≤15mg/kg 的患者并发症发生率较低。
本荟萃分析提供了强有力的证据，表明 TXA 是一种安全有效的药物，可减少髋部骨折手术中的围手术期失血。与较高剂量相比，单次剂量 15mg/kg 与不良事件的非显著减少相关，同时达到可比的效果。
