Tanashat Mohammad, Khalefa Basma Badrawy, Manasrah AlMothana, Abu Suilik Husam, Abouzid Mohamed, Shehada Wafaa, Almasry Ahmed, Atiq Ibrar, Abuelazm Mohamed
Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clin Appl Thromb Hemost. 2025 Jan-Dec;31:10760296251342467. doi: 10.1177/10760296251342467. Epub 2025 May 19.
BackgroundTranexamic acid (TA), a synthetic lysine derivative, is known for its antifibrinolytic effect and potential to reduce bleeding in surgeries like arthroplasty, cardio-aortic procedures, and liver transplantation. This meta-analysis seeks to provide robust clinical evidence on TA's effectiveness in reducing blood loss and transfusion needs during orthotopic liver transplantation.MethodsThe systematic review and meta-analysis included the relevant randomized controlled trials (RCTs) retrieved from PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS databases until August 2024. The meta-analysis was done using (RevMan 5.4.1). PROSPERO ID: CRD42024589151.ResultsOur meta-analysis of seven RCTs with 1875 patients found no significant differences between TA and control groups in total red blood cell units transfused (MD: -3.74 units; 95% CI [-8.49, 1.01]; = .12), perioperative transfusions (MD: -0.42 units; 95% CI [-3.17, 2.32]; = .76), or overall blood loss (MD: -167.81 mL; 95% CI [-415.29, 79.67]; = .18).For safety outcomes, TA was associated with a higher rate of venous thromboembolism events (RR: 1.71; 95% CI [1.01, 2.87]; = .05; event rate: 4.89% vs 2.91%), while no significant differences were found in other surgical complications (RR: 1.12; 95% CI [0.92, 1.37]; = .26).ConclusionTA does not reduce blood loss or the need for postoperative transfusions in orthotopic liver transplantation and may raise thrombotic risk. Caution is required to interpret these results due to variations in the study/hospital-specific transfusion protocol details. Larger studies are needed to confirm these findings, and future research should explore the effects of multiple dosing regimens on blood loss and transfusion requirements.
背景
氨甲环酸（TA）是一种合成赖氨酸衍生物，以其抗纤维蛋白溶解作用以及在关节置换术、心脏主动脉手术和肝移植等手术中减少出血的潜力而闻名。本荟萃分析旨在提供有力的临床证据，证明TA在原位肝移植期间减少失血和输血需求方面的有效性。
方法
系统评价和荟萃分析纳入了截至2024年8月从PubMed、EMBASE、Web of Science、Cochrane和SCOPUS数据库检索到的相关随机对照试验（RCT）。荟萃分析使用（RevMan 5.4.1）进行。PROSPERO编号：CRD42024589151。
结果
我们对7项RCT（共1875例患者）的荟萃分析发现，TA组和对照组在输注的红细胞总量（MD：-3.74单位；95%CI[-8.49，1.01]；P = 0.12）、围手术期输血（MD：-0.42单位；95%CI[-3.17，2.32]；P = 0.76）或总失血量（MD：-167.81 mL；95%CI[-415.29，79.67]；P = 0.18）方面无显著差异。
在安全性结果方面，TA与静脉血栓栓塞事件发生率较高相关（RR：1.71；95%CI[1.01，2.87]；P = 0.05；事件发生率：4.89%对2.91%），而在其他手术并发症方面未发现显著差异（RR：1.12；95%CI[0.92，1.37]；P = 0.26）。
结论
TA在原位肝移植中不能减少失血或术后输血需求，且可能增加血栓形成风险。由于研究/医院特定输血方案细节存在差异，需要谨慎解读这些结果。需要更大规模的研究来证实这些发现，未来的研究应探索多种给药方案对失血和输血需求的影响。
