Ghorbani Mohammad, Sadrian Seyed Hassan, Ghaderpanah Rezvan, Neitzke Colin C, Chalmers Brian P, Esmaeilian Saeid, Rahmanipour Elham, Parsa Ali
Orthopedic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Students Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
J Orthop. 2024 Mar 18;54:90-102. doi: 10.1016/j.jor.2024.03.010. eCollection 2024 Aug.
This comprehensive review was conducted to assess the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE) risk, and wound complications following total hip arthroplasty (THA). Additionally, it sought to evaluate the effects of various TXA dosages, modes of administration, and combinations with other antifibrinolytic drug.
In search of systematic reviews and meta-analyses on the use of TXA in THA patients, we searched extensively through databases including Scopus, the Cochrane Library, Embase, Medline, the Web of Science, PubMed, and Google Scholar. We discovered 23 meta-analyses covering 32,442 patients overall that fulfilled our study criteria, spanning the period from the creation of these databases until May 2023.
This comprehensive review's meta-analyses, which together examined over 35,000 patients, repeatedly demonstrated how TXA administration during THA successfully lowers perioperative blood loss and the need for transfusions. TXA reduced total blood loss by an average of 151-370 ml, postoperative hemoglobin levels by 0.5-1.1 g/dL, and transfusion rates by 19-26% on average when compared to control groups. The information gathered did not indicate that using TXA significantly increased the risk of VTE or wound complications. When comparing different TXA doses, administration techniques, or its use in conjunction with other anti-fibrinolytic therapies, no discernible differences were found in terms of efficacy or safety outcomes.
The comprehensive review clearly indicates that TXA improves THA outcomes without increasing the risk of adverse events by lowering blood loss and the requirement for transfusions. This insightful information can help surgeons decide whether to use TXA during THA procedures.
进行这项全面综述以评估氨甲环酸（TXA）对全髋关节置换术（THA）后失血、静脉血栓栓塞（VTE）风险及伤口并发症的影响。此外，还旨在评估不同TXA剂量、给药方式以及与其他抗纤溶药物联合使用的效果。
为了查找关于TXA在THA患者中应用的系统评价和荟萃分析，我们广泛检索了包括Scopus、Cochrane图书馆、Embase、Medline、科学网、PubMed和谷歌学术在内的数据库。我们发现了23项荟萃分析，总共涵盖32442例符合我们研究标准的患者，时间跨度从这些数据库创建至2023年5月。
这项全面综述的荟萃分析共纳入超过35000例患者，反复表明THA期间使用TXA可成功减少围手术期失血及输血需求。与对照组相比，TXA平均使总失血量减少151 - 370毫升，术后血红蛋白水平降低0.5 - 1.1克/分升，输血率平均降低19 - 26%。收集到的信息未表明使用TXA会显著增加VTE或伤口并发症的风险。在比较不同TXA剂量、给药技术或其与其他抗纤溶疗法联合使用时，在疗效或安全性结果方面未发现明显差异。
该全面综述明确表明，TXA通过减少失血和输血需求改善了THA的结局，且未增加不良事件风险。这些有见地的信息可帮助外科医生决定在THA手术中是否使用TXA。
