Department of Orthopedics, People's Hospital of Nanchuan District, Nanchuan District, Chongqing, 408400, China.
BMC Emerg Med. 2024 Oct 25;24(1):202. doi: 10.1186/s12873-024-01119-2.
The use of prehospital tranexamic acid (TXA) in patients with trauma has attracted considerable attention. This systematic review and meta-analysis aimed to provide the best evidence for clinicians.
All related literature in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Central) databases were searched systematically from their establishment to July 1, 2023. The outcome measures included 24-hour and 28-30-day mortality and adverse events (multiple organ dysfunction syndrome, acute respiratory distress syndrome, thrombotic events, and infection events). The Revised Cochrane Risk of Bias Tool for Randomized Trials was used to evaluate the quality of the randomized controlled trials (RCTs). The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the risk of bias in non-RCTs. The required information size was estimated using trial sequential analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to evaluate the evidence quality.
Eleven studies (comprising 11,259 patients) were included; two of these were RCTs. The overall risks of bias were low in the RCTs. ROBINS-I risk of bias was Moderate in 3 studies, serious in 5 studies, and critical in 1 study. A significant reduction in 24-hour mortality was observed (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.94). A subgroup analysis that included only RCTs revealed that prehospital TXA was associated with reduced 28-30-day mortality (OR, 0.80; 95% CI, 0.66-0.97) and increased risks of thromboembolism (OR, 1.22; 95% CI, 1.03-1.44) and infection (OR, 1.13; 95% CI, 1.00-1.28) events. The blood products for transfusion decreased by 2.3 units on average (weighted mean difference [WMD], - 2.30; 95%CI, - 3.59 to - 1.01).
This updated systematic review showed that prehospital TXA reduced the 24-hour and 28-38-day mortality and blood transfusion but increased the risks of infection and thromboembolism in patients with trauma. Future RCTs with larger and more homogeneous samples will help verify our results.
创伤患者使用院前氨甲环酸（TXA）引起了广泛关注。本系统评价和荟萃分析旨在为临床医生提供最佳证据。
系统检索 PubMed、Embase 和 Cochrane 中心对照试验注册库（Central）从建库至 2023 年 7 月 1 日的相关文献。结局指标包括 24 小时和 28-30 天死亡率和不良事件（多器官功能障碍综合征、急性呼吸窘迫综合征、血栓事件和感染事件）。采用修订后的 Cochrane 随机对照试验偏倚风险工具评估随机对照试验（RCT）的质量。采用非随机研究方法学指数（MINORS）评估非 RCT 的偏倚风险。采用试验序贯分析估计所需信息量。采用推荐、评估、发展和评估方法评估证据质量。
纳入 11 项研究（共 11259 例患者），其中 2 项为 RCT。RCT 的整体偏倚风险较低。3 项研究的 ROBINS-I 偏倚风险为中度，5 项研究为严重，1 项研究为关键。24 小时死亡率显著降低（比值比 [OR]，0.82；95%置信区间 [CI]，0.71-0.94）。仅纳入 RCT 的亚组分析显示，院前 TXA 与降低 28-30 天死亡率（OR，0.80；95%CI，0.66-0.97）和增加血栓栓塞（OR，1.22；95%CI，1.03-1.44）和感染（OR，1.13；95%CI，1.00-1.28）事件风险相关。平均输血的血液制品减少 2.3 单位（加权均数差 [WMD]，-2.30；95%CI，-3.59 至-1.01）。
本更新的系统评价表明，院前 TXA 降低了创伤患者的 24 小时和 28-38 天死亡率和输血需求，但增加了感染和血栓栓塞的风险。未来需要更大和更同质样本的 RCT 来帮助验证我们的结果。
