口服与静脉注射氨甲环酸治疗全膝及全髋关节置换后出血的Meta分析

Meta-analysis of efficacy of oral versus intravenous tranexamic acid in reducing blood loss after total knee and hip arthroplasties

背景:接受全膝关节或全髋关节置换的患者可用氨甲环酸减少出血量,氨甲环酸有多种给药方式,目前对于氨甲环酸的最佳使用途径仍然存在较大争议。目的:对比评价口服与静脉注射氨甲环酸治疗全膝关节及全髋关节置换后出血的疗效及安全性。方法:全面检索PubMed、Cochrane Library、Embase、Web of Science等数据库,检索时限为各数据库建库时间至2019年5月,收集以口服及静脉应用氨甲环酸减少全膝或全髋关节置换术后出血的临床随机对照试验,提取资料并进行方法学质量评估。采用Revman 5.3对纳入结果进行Meta分析。结果与结论:①9篇文献纳入研究,共1 080例患者;②Meta分析结果显示,口服与静脉注射氨甲环酸术后总失血量差异无显著性意义[MD=1.43,95%CI(-40.02-42.88),P=0.95],术后血红蛋白减少量差异无显著性意义[MD=-0.03,95%CI(-0.11-0.05),P=0.45];③口服与静脉注射氨甲环酸术后输血率差异无显著性意义[RR=0.91,95%CI(0.55-1.49),P=0.70],术后深静脉血栓发生率差异无显著性意义[RR=0.43,95%CI(0.11-1.64),P=0.22],术后住院时间差异无显著性意义[MD=0.00,95%CI(-0.03-0.03),P=0.93];④结果表明,口服与静脉注射氨甲环酸有着类似的功效和临床价值。但是由于纳入文献量较少且质量有限,尚需方法科学的大样本、多中心、高质量临床随机对照试验来进行进一步验证。

BACKGROUND:Tranexamic acid can effectively reduce the blood loss of total knee or hip arthroplasties.Tranexamic acid can be administered in a variety of ways;however,there is still much controversy about the best use of tranexamic acid.OBJECTIVE:To compare the efficacy and safety between oral and intravenous tranexamic acid for blood loss after total knee and hip arthroplasties.METHODS: Randomized controlled trials concerning oral tranexamic acid and intravenous tranexamic acid for reducing blood loss after totalknee and hip arthroplasties were retrieved from PubMed, Cochrane Library, Embase and Web of Science databases from inception to May2019. The data were extracted for the methodological quality. Then meta-analysis was conducted by Revman 5.3 software.RESULTS AND CONCLUSION: Nine randomized controlled trials involving 1 080 cases were included. The results of this meta-analysisshowed that there were no significant differences in total blood loss [MD=1.43, 95%CI(-40.02-42.88), P=0.95], postoperative hemoglobindecline [MD=-0.03, 95%CI(-0.11-0.05), P=0.45], transfusion rate [RR=0.91, 95%CI(0.55-1.49), P=0.70], deep vein thrombosis rate[RR=0.43,95%CI(0.11-1.64), P=0.22], or hospitalization time [MD=0.00, 95%CI(-0.03-0.03), P=0.93] between two groups. These results indicate thatoral tranexamic acid shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasties. However, due to thelow number and limited quality of included studies, more randomized controlled trials with large samples should be rigorously designed toverify the conclusion.