Division of Thoracic Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada.
King Faisal Specialist Hospital and Research Centre Organ Transplant Center of Excellence, Riyadh, Saudi Arabia.
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231218215. doi: 10.1177/10760296231218215.
Bleeding remains a common complication post-thoracic surgery. Although intravenous tranexamic acid (TXA) has been shown to decrease blood loss, its use has been associated with adverse effects. Accordingly, topical TXA has been proposed as an alternative to reduce bleeding with fewer systemic complications.
We searched Medline, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing topical TXA versus control (i.e., placebo) in patients undergoing thoracic procedures. The primary outcome was total postoperative blood loss at 24 hours. Secondary outcomes included were the number of red blood cell (RBC) transfusions, and hospital length of stay (LOS). Meta-analyses were pooled using mean difference with inverse-variance weighting and random-effects.
Out of the 575 unique studies that were screened, we identified three randomized controlled trials (RCTs) involving 399 patients. Out of the three RCTs analyzed, two studies, accounting for 67% of the total, were found to have a low risk of bias. The primary outcome of 24-h post-operative blood loss was significantly lower in patients who received TXA (mean difference [MD] -93.6 ml, 95% CI -121.8 to -65.4 ml, I= 45%). In addition, the need for RBC transfusion was significantly lower in the topical TXA group compared to control (MD -0.5 units, 95% CI -0.8 to -0.3 units, I= 60%). However, there was no significant difference in the hospital length of stay (LOS) (MD -0.3 days, 95% CI -0.9 to 0.4 days, I= 0%). These results remained consistent after several sensitivity analyses. The use of topical intrapleural tranexamic acid has also been found to be safe without any significant safety concerns.
Topical intrapleural TXA reduces blood loss and the need for blood transfusions during thoracic surgery. In addition, there is no evidence of the increased safety concerns associated with its use. Larger trials are necessary to validate these findings and evaluate the safety and efficacy of different dosages.
出血仍然是胸部手术后常见的并发症。尽管静脉注射氨甲环酸（TXA）已被证明可减少失血，但它的使用与不良反应有关。因此，局部使用 TXA 已被提议作为减少出血的替代方法，其全身并发症较少。
我们在 Medline、Embase 和 Cochrane Central 数据库中检索了比较局部 TXA 与对照（即安慰剂）在接受胸部手术的患者中的随机对照试验（RCT）。主要结局是术后 24 小时的总术后失血量。次要结局包括红细胞（RBC）输血的数量和住院时间（LOS）。使用均值差和倒数方差加权法进行了荟萃分析，并采用随机效应模型。
在筛选出的 575 篇独特研究中，我们确定了三项涉及 399 名患者的随机对照试验（RCT）。在分析的三项 RCT 中，有两项（占总数的 67%）被发现存在低偏倚风险。接受 TXA 的患者术后 24 小时的主要结局（24 小时内失血量）明显较低（平均差值 [MD] -93.6ml，95%CI -121.8 至 -65.4ml，I=45%）。此外，与对照组相比，局部 TXA 组的 RBC 输血需求明显降低（MD -0.5 单位，95%CI -0.8 至 -0.3 单位，I=60%）。然而，两组间住院时间（LOS）差异无统计学意义（MD -0.3 天，95%CI -0.9 至 0.4 天，I=0%）。这些结果在进行了几次敏感性分析后仍然一致。局部使用胸腔内 TXA 也被发现是安全的，没有明显的安全问题。
局部胸腔内 TXA 可减少胸部手术后的失血量和输血需求。此外，没有证据表明其使用与安全性问题有关。需要更大规模的试验来验证这些发现，并评估不同剂量的安全性和疗效。
