Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2023 Apr;15(4):930-946. doi: 10.1111/os.13678. Epub 2023 Mar 6.
The optimal dose and efficacy of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in total knee arthroplasty (TKA) were under controversial, and we aimed to make comparisons between different doses of TXA and EACA in intravenous (IV) or intra-articular (IA) applications in patients undergoing TKA.
This network meta-analysis was guided by the Priority Reporting Initiative for Systematic Assessment and Meta-Analysis (PRISMA). According to the administrations of antifibrinolytic agents, patients in eligible studies were divided into three subgroups: (i) IA applications of TXA and EACA; (ii) IV applications (g) of TXA and EACA; (iii) IV applications (mg/kg) of TXA and EACA. Total blood loss (TBL), hemoglobin (HB) drops and transfusion rates were the primary outcomes, while drainage volume, pulmonary embolism (PE) or deep vein thrombosis (DVT) risk were the secondary outcomes. A multivariate Bayesian random-effects model was adopted in the network analysis.
A total of 38 eligible trials with different regimens were assessed. Overall inconsistency and heterogeneity were acceptable. Taking all primary outcomes into account, 1.0-3.0 g TXA were most effective in IA applications, 1-6 g TXA and 10-14 g EACA were most effective in IV applications (g), while 30 mg/kg TXA and 150 mg/kg EACA were most effective in IV applications (mg/kg). None of the regimens showed increasing risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) compared with placebo.
0 g IA TXA, 1.0 g IV TXA or 10.0 g IV EACA, as well as 30 mg/kg IV TXA or 150 mg/kg IV EACA were most effective and enough to control bleeding for patients after TKA. TXA was at least 5 times more potent than EACA.
氨甲环酸（TXA）和ε-氨基己酸（EACA）在全膝关节置换术（TKA）中的最佳剂量和疗效存在争议，本研究旨在比较 TKA 患者静脉（IV）或关节内（IA）应用不同剂量 TXA 和 EACA 的效果。
本网络荟萃分析遵循系统评估和荟萃分析优先报告倡议（PRISMA）。根据抗纤维蛋白溶解药物的使用情况，将符合条件的研究中的患者分为三组：（i）TXA 和 EACA 的 IA 应用；（ii）TXA 和 EACA 的 IV 应用（g）；（iii）TXA 和 EACA 的 IV 应用（mg/kg）。总失血量（TBL）、血红蛋白（HB）下降和输血率为主要结局，引流体积、肺栓塞（PE）或深静脉血栓形成（DVT）风险为次要结局。网络分析采用多变量贝叶斯随机效应模型。
共评估了 38 项不同方案的合格试验。总体不一致性和异质性可以接受。综合所有主要结局，IA 应用中 1.0-3.0 g TXA 最有效，IV 应用（g）中 1-6 g TXA 和 10-14 g EACA 最有效，而 IV 应用（mg/kg）中 30 mg/kg TXA 和 150 mg/kg EACA 最有效。与安慰剂相比，任何方案均未增加肺栓塞（PE）或深静脉血栓形成（DVT）的风险。
0 g IA TXA、1.0 g IV TXA 或 10.0 g IV EACA 以及 30 mg/kg IV TXA 或 150 mg/kg IV EACA 对 TKA 后患者的止血效果最有效且足够。TXA 的效力至少是 EACA 的 5 倍。
