氨甲环酸可能使已有血栓栓塞风险的全关节置换术患者受益：一项系统评价和荟萃分析。

Tranexamic acid may benefit patients with preexisting thromboembolic risk undergoing total joint arthroplasty: a systematic review and meta-analysis.

作者信息

Dang Xiangji, Liu Mei, Yang Qiang, Jiang Jin, Liu Yan, Sun Hui, Tian Jinhui

机构信息

Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China.

Department of Pharmaceutical, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China.

出版信息

EFORT Open Rev. 2024 Jun 3;9(6):467-478. doi: 10.1530/EOR-23-0140.

DOI:10.1530/EOR-23-0140

PMID:38828967

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11195339/

Abstract

PURPOSE

This study sought to determine if the use of tranexamic acid (TXA) in preexisting thromboembolic risk patients undergoing total joint arthroplasty (TJA) was linked to an increased risk of death or postoperative complications.

METHODS

We conducted a comprehensive search for studies up to May 2023 in PubMed, Web of Science, EMBASE, and the Cochrane Library. We included randomized clinical trials, cohort studies, and case-control studies examining the use of TXA during TJA surgeries on high-risk patients. The Cochrane Risk of Bias instrument was used to gauge the excellence of RCTs, while the MINORS index was implemented to evaluate cohort studies. We used mean difference (MD) and relative risk (RR) as effect size indices for continuous and binary data, respectively, along with 95% CIs.

RESULTS

Our comprehensive study, incorporating data from 11 diverse studies involving 812 993 patients, conducted a meta-analysis demonstrating significant positive outcomes associated with TXA administration. The findings revealed substantial reductions in critical parameters, including overall blood loss (MD = -237.33; 95% CI (-425.44, -49.23)), transfusion rates (RR = 0.45; 95% CI (0.34, 0.60)), and 90-day unplanned readmission rates (RR = 0.86; 95% CI (0.76, 0.97)). Moreover, TXA administration exhibited a protective effect against adverse events, showing decreased risks of pulmonary embolism (RR = 0.73; 95% CI (0.61, 0.87)), myocardial infarction (RR = 0.47; 95% CI (0.40-0.56)), and stroke (RR = 0.73; 95% CI (0.59-0.90)). Importantly, no increased risk was observed for mortality (RR = 0.53; 95% CI (0.24, 1.13)), deep vein thrombosis (RR = 0.69; 95% CI (0.44, 1.09)), or any of the evaluated complications associated with TXA use.

CONCLUSION

The results of this study indicate that the use of TXA in TJA patients with preexisting thromboembolic risk does not exacerbate complications, including reducing mortality, deep vein thrombosis, and pulmonary embolism. Existing evidence strongly supports the potential benefits of TXA in TJA patients with thromboembolic risk, including lowering blood loss, transfusion, and readmission rates.

摘要

目的

本研究旨在确定在接受全关节置换术（TJA）且已有血栓栓塞风险的患者中使用氨甲环酸（TXA）是否与死亡风险或术后并发症增加有关。

方法

我们对截至2023年5月的研究进行了全面检索，检索数据库包括PubMed、科学网、EMBASE和考克兰图书馆。我们纳入了随机临床试验、队列研究和病例对照研究，这些研究考察了在TJA手术中对高危患者使用TXA的情况。考克兰偏倚风险工具用于评估随机对照试验的质量，而MINORS指数用于评估队列研究。对于连续数据和二分类数据，我们分别使用平均差（MD）和相对风险（RR）作为效应量指标，并给出95%置信区间。

结果

我们的综合研究纳入了11项不同研究的数据，涉及812993名患者，进行了荟萃分析，结果显示使用TXA有显著的积极效果。研究结果表明，关键参数有大幅降低，包括总失血量（MD = -237.33；95%置信区间（-425.44，-49.23））、输血率（RR = 0.45；95%置信区间（0.34，0.60））和90天非计划再入院率（RR = 0.86；95%置信区间（0.76，0.97））。此外，使用TXA对不良事件有保护作用，肺栓塞风险降低（RR = 0.73；95%置信区间（0.61，0.87））、心肌梗死风险降低（RR = 0.47；95%置信区间（0.40 - 0.56））、中风风险降低（RR = 0.73；95%置信区间（0.59 - 0.90））。重要的是，未观察到死亡率（RR = 0.53；95%置信区间（0.24，1.13））、深静脉血栓形成（RR = 0.69；95%置信区间（0.44，1.09））或与使用TXA相关的任何评估并发症的风险增加。