Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, Hainan Province, China.
Department of Emergency and Trauma Surgery, The First Affiliated Hospital of Hainan Medical University, Longhua District, Haikou, Hainan Province, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e33876. doi: 10.1097/MD.0000000000033876.
Tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) have been demonstrated to reduce blood loss following total knee arthroplasty (TKA). This meta-analysis aimed to compare the efficacy and safety of TXA and EACA in reducing blood loss in primary TKA patients.
A search of the PubMed, Embase, and Cochrane Library databases identified all relevant studies published until December 2022. Randomized controlled trials (RCTs) reporting a comparison of TXA and EACA for TKA patients were selected. The main outcomes were total blood loss (TBL), hemoglobin (Hb) drop on postoperative day 3, intraoperative blood loss, operation time and the transfusion rate were evaluated. The weighted mean differences (WMD) and risk ratio (RR) with 95% confidence intervals (CI) were calculated using a fixed-effects or random-effects model. Stata 12.0 software was used for meta-analysis.
Six studies involving 739 (TXA:372; EACA:367) patients were included in this meta-analysis. There was no significant difference in terms of intraoperative blood loss, Hb drop on postoperative day 3, operation time, tourniquet time (TT), transfusion rate and the occurrence of deep venous thrombosis (DVT) between the 2 treatments groups. However, compared with EACA, TXA significant reduced TBL (WMD, 174.60; 95% CI, -244.09 to -105.11).
Our research did not demonstrate TXA to be superior to EACA in reducing need for transfusion and Hb drop. TXA was superior than EACA in reducing TBL in TKA patients. More RCTs with identical inclusion criteria and dose and duration of treatment, are required to confirm these findings.
氨甲环酸（TXA）和氨基己酸（EACA）已被证明可减少全膝关节置换术（TKA）后的失血。本荟萃分析旨在比较 TXA 和 EACA 在减少初次 TKA 患者失血方面的疗效和安全性。
检索PubMed、Embase 和 Cochrane Library 数据库，直到 2022 年 12 月，检索所有相关研究。选择报告 TXA 和 EACA 用于 TKA 患者比较的随机对照试验（RCT）。主要结局是总失血量（TBL）、术后第 3 天血红蛋白（Hb）下降、术中失血量、手术时间和输血率。使用固定效应或随机效应模型计算加权均数差（WMD）和风险比（RR）及 95%置信区间（CI）。使用 Stata 12.0 软件进行荟萃分析。
纳入 6 项研究共 739 例（TXA：372 例；EACA：367 例）患者。两组间术中失血量、术后第 3 天 Hb 下降、手术时间、止血带时间（TT）、输血率和深静脉血栓形成（DVT）发生率无显著差异。然而，与 EACA 相比，TXA 显著减少 TBL（WMD，-244.09 至-105.11）。
本研究未显示 TXA 在减少输血需求和 Hb 下降方面优于 EACA。TXA 可减少 TKA 患者的 TBL，但需要更多具有相同纳入标准、剂量和治疗时间的 RCT 来证实这些发现。
