Zhang Jin, Yang Zi-Quan
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
Zhongguo Gu Shang. 2022 May 25;35(5):484-90. doi: 10.12200/j.issn.1003-0034.2022.05.015.
To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software.
A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [=-88.60, 95%(-260.30, 83.10), =0.31], blood transfusion rate [=1.48, 95%(0.96, 2.27), =0.08], thrombotic complications [=0.80, 95%(0.07, 8.83), =0.85], per capita hemoglobin input [=0.04, 95%(-0.02, 0.10), =0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [=-147.13, 95%(-216.52, -77.74), <0.0001], the difference was statistically significant. The blood transfusion rate [=1.30, 95%(0.74, 2.28), =0.37], thrombotic complications [=0.95, 95%(0.38, 2.36), =0.92], per capita hemoglobin input [=-0.00, 95%(-0.05, 0.06), =0.48], tourniquet time [=1.54, 95%(-2.07, 5.14), =0.40] were similar between two groups, the difference was not statistically significant.
In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.
系统评价氨甲环酸和氨基己酸在全髋关节置换术（THA）和全膝关节置换术（TKA）中的止血效果。
通过电子检索PubMed、EMbase、Cochrane图书馆、中国知网（CNKI）、万方、维普数据库，检索自建库至2020年7月关于氨甲环酸和氨基己酸用于THA或TKA比较的随机对照试验（RCT）和回顾性病例对照研究。两名研究者分别根据纳入和排除标准进行文献筛选和数据提取。纳入的随机对照研究的方法学质量通过Cochrane手册进行评价，纳入的回顾性病例对照研究的方法学质量通过NOS量表进行评价。采用Review Manager 5.3软件对失血量、血栓形成并发症发生率、人均血红蛋白输入量进行Meta分析。
共纳入6篇文献，其中4篇RCT和2篇回顾性病例对照研究。共3174例患者，其中氨甲环酸组1353例，氨基己酸组1821例。Meta分析结果显示，THA期间氨甲环酸组和氨基己酸组在失血量[MD=-88.60，95%CI（-260.30，83.10），P=0.31]、输血率[RR=1.48，95%CI（0.96，2.27），P=0.08]、血栓形成并发症[RR=0.80，95%CI（0.07，8.83），P=0.85]、人均血红蛋白输入量[MD=0.04，95%CI（-0.02，0.10），P=0.18]方面差异无统计学意义。而在TKA中，氨甲环酸组失血量少于氨基己酸组[MD=-147.13，95%CI（-216.52，-77.74），P<0.0001]，差异有统计学意义。两组输血率[RR=1.30，95%CI（0.74，2.28），P=0.37]、血栓形成并发症[RR=0.95，95%CI（0.38，2.36），P=0.92]、人均血红蛋白输入量[MD=-0.00，95%CI（-0.05，0.06），P=0.48]、止血带时间[MD=1.54，95%CI（-2.07，5.14），P=0.40]相似，差异无统计学意义。
在THA中，氨甲环酸和氨基己酸止血效果相似，而在TKA中，氨甲环酸能有效减少患者失血量，止血效果更佳。推荐氨甲环酸作为TKA的首选止血药物之一。
