Alsaied Mohamed A, El-Sayed Omnia Samy, Alqato Shahd, Elettreby Abdelrahman M, Abo Elnaga Ahmed A
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Faculty of Medicine, Zagazig University, Zagazig, Sharqia, Egypt.
J Orthop Surg Res. 2025 Jul 17;20(1):668. doi: 10.1186/s13018-025-06038-x.
Persistent bleeding and inflammation during and after surgery are frequent problems in hip and knee surgeries that lead to high blood transfusion needs and slow recovery. Tranexamic acid (TXA) is a popular agent used to control bleeding, but its efficacy may be improved when combined with Carbazochrome sodium sulfate (CSS), capillary hemostatic agent that stabilizes microvascular integrity and reduces capillary bleeding. This meta-analysis compares the efficacy and safety of CSS plus TXA and TXA alone in controlling bleeding during surgery, inflammation, and postoperative outcomes.
A thorough literature search was performed across multiple databases until January 2025 to identify pertinent randomized controlled trials comparing the efficacy and safety of the combination of Carbazochrome sodium sulfate and Tranexamic acid against Tranexamic acid alone for the reduction of blood loss. The study's primary outcomes were total blood loss, hidden blood loss, intraoperative blood loss, and maintenance of hemoglobin levels. The quality of the studies included was evaluated utilizing the RoB 2 tool. Subsequent to data extraction, a meta-analysis was conducted utilizing RevMan 5 software with a random effects model.
This systematic review identified six studies (n = 800 patients) fulfilling research criteria. The meta-analysis has shown that there was a robust reduction in total blood loss (MD = -230.92 mL, 95% CI [-271.69 to -190.14], P < 0.00001) and hidden blood loss (MD = -220.52 mL, 95% CI [-263.78 to -177.27], P < 0.00001) when comparing the intervention group with TXA alone with topical administration providing less blood loss than Intravenous. In addition to the above measure, hemoglobin preservation was also improved (MD = -0.59 g/dL, 95% CI [-0.73 to -0.46], P < 0.00001). Furthermore, compared to TXA alone, the combination group had much lower requirements for blood transfusion (RR = 0.13, 95% CI [0.04 to 0.38], P = 0.0003) while there was no increase in complication with wounds or venous thromboembolism.
The use of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) proves to be more effective at controlling bleeding, hemoglobin loss, postoperative inflammation, and pain after hip and knee arthroplasty than using TXA alone. There was also increased efficacy from topical application, as well as increased safety and decreased transfusion use. Combination therapy had good results; however, its relative inefficacy on operative duration and duration of hospital admissions indicates that more work needs to be done on this issue.
髋膝关节手术期间及术后持续出血和炎症是常见问题，会导致大量输血需求和恢复缓慢。氨甲环酸（TXA）是一种常用的止血药物，但与卡巴克洛钠（CSS）联合使用时，其疗效可能会提高。卡巴克洛钠是一种毛细血管止血剂，可稳定微血管完整性并减少毛细血管出血。本荟萃分析比较了CSS联合TXA与单独使用TXA在控制手术期间出血、炎症及术后结局方面的疗效和安全性。
在多个数据库中进行了全面的文献检索，直至2025年1月，以确定比较卡巴克洛钠和氨甲环酸联合使用与单独使用氨甲环酸减少失血疗效和安全性的相关随机对照试验。该研究的主要结局指标为总失血量、隐性失血量、术中失血量和血红蛋白水平维持情况。使用RoB 2工具评估纳入研究的质量。数据提取后，使用RevMan 5软件采用随机效应模型进行荟萃分析。
本系统评价确定了6项符合研究标准的研究（n = 800例患者）。荟萃分析表明，与单独使用TXA的干预组相比，联合使用CSS和TXA可显著减少总失血量（MD = -230.92 mL，95%CI [-271.69至-190.14]，P < 0.00001）和隐性失血量（MD = -220.52 mL，95%CI [-263.78至-177.27]，P < 0.00001），局部给药的失血量少于静脉给药。除上述指标外，血红蛋白的维持情况也得到改善（MD = -0.59 g/dL，95%CI [-0.73至-0.46]，P < 0.00001）。此外，与单独使用TXA相比，联合治疗组的输血需求更低（RR = 0.13，95%CI [0.04至0.38]，P = 0.0003），且伤口或静脉血栓栓塞并发症未增加。
事实证明，与单独使用TXA相比，卡巴克洛钠（CSS）联合氨甲环酸（TXA）在控制髋膝关节置换术后出血、血红蛋白丢失、术后炎症和疼痛方面更有效。局部应用的疗效也有所提高，安全性增加，输血使用减少。联合治疗取得了良好的效果；然而，其对手术时间和住院时间相对无效，表明在这个问题上还需要做更多的工作。
