PDF(Pubmed)
Abstract：
OBJECTIVE: With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty.
METHODS: PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane\'s guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging.
RESULTS: Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = - 65.60, 95% confidence interval (CI) [- 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [- 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [- 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = - 0.13), 95% CI [- 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [- 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [- 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study.
CONCLUSIONS: 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.
METHODS: PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane\'s guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging.
RESULTS: Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = - 65.60, 95% confidence interval (CI) [- 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [- 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [- 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = - 0.13), 95% CI [- 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [- 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [- 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study.
CONCLUSIONS: 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.
摘要：
目的：随着髋关节和膝关节骨性关节炎患病率的增加，总关节置换，终末期治疗，提供疼痛缓解和功能恢复，但通常与大量失血有关。据报道，氨甲环酸（TXA）可减少髋关节或膝关节置换术的围手术期失血量。然而,TXA给药的最佳剂量仍存在争议。因此,我们进行了一项荟萃分析,结合了5项试验的数据,比较了1个固定剂量的1g静脉给药TXA和2个剂量的1g静脉给药用于髋关节或膝关节置换术的疗效和安全性.
方法：PubMed，Medline,Embase,WebofScience,从2000年1月到2023年2月，搜索了Cochrane图书馆。我们的荟萃分析包括随机对照试验和队列研究，比较不同剂量的静脉TXA（IV-TXA）用于THA或TKA的疗效和安全性。观察终点包括总失血量，术后血红蛋白下降,输血率,住院时间,深静脉血栓形成（DVT）的发生率，和肺栓塞（PE）的发生率。根据Cochrane指南和PRISMA声明进行Meta分析。丹麦RevMan5.3软件用于数据合并。
结果：涉及5542例患者的5项队列研究符合纳入标准。我们的荟萃分析表明，两组的总失血量明显更高（均差（MD）=-65.60，95％置信区间（CI）[-131.46，0.26]，P=0.05）；输血率（风险差（RD）=0.00，95％CI[-0.01，0.02]，P=0.55);术后血红蛋白(MD=0.02,95%CI[-0.09,0.13],P=0.31）；术后住院天数（MD=-0.13），95%CI[-0.35，0.09]，P=0.25）；DVT（RD=0.00，95%CI[-0.00，0.01]，P=0.67）；PE（RD=0.00，95%CI[-0.01，0.00]，P=0.79）。由于每个主要研究的样本量差异，因此存在一些固有的异质性。
结论：每次1剂1克和2剂1克IV-TXA对减少失血具有相似的效果，输血率,术后血红蛋白水平,TKA或THA术后住院时间，不增加术后并发症风险。对于血栓栓塞事件高风险的患者，在整个手术中1克TXA的剂量可能是优选的。然而,需要更高质量的RCT来探索最佳方案剂量,以推荐在全关节置换术中广泛使用TXA.试验注册我们进行了文献选择，资格标准评估，2023年3月16日在Prospero（CRD42023405387）注册的研究计划的数据提取和分析。
方法：PubMed，Medline,Embase,WebofScience,从2000年1月到2023年2月，搜索了Cochrane图书馆。我们的荟萃分析包括随机对照试验和队列研究，比较不同剂量的静脉TXA（IV-TXA）用于THA或TKA的疗效和安全性。观察终点包括总失血量，术后血红蛋白下降,输血率,住院时间,深静脉血栓形成（DVT）的发生率，和肺栓塞（PE）的发生率。根据Cochrane指南和PRISMA声明进行Meta分析。丹麦RevMan5.3软件用于数据合并。
结果：涉及5542例患者的5项队列研究符合纳入标准。我们的荟萃分析表明，两组的总失血量明显更高（均差（MD）=-65.60，95％置信区间（CI）[-131.46，0.26]，P=0.05）；输血率（风险差（RD）=0.00，95％CI[-0.01，0.02]，P=0.55);术后血红蛋白(MD=0.02,95%CI[-0.09,0.13],P=0.31）；术后住院天数（MD=-0.13），95%CI[-0.35，0.09]，P=0.25）；DVT（RD=0.00，95%CI[-0.00，0.01]，P=0.67）；PE（RD=0.00，95%CI[-0.01，0.00]，P=0.79）。由于每个主要研究的样本量差异，因此存在一些固有的异质性。
结论：每次1剂1克和2剂1克IV-TXA对减少失血具有相似的效果，输血率,术后血红蛋白水平,TKA或THA术后住院时间，不增加术后并发症风险。对于血栓栓塞事件高风险的患者，在整个手术中1克TXA的剂量可能是优选的。然而,需要更高质量的RCT来探索最佳方案剂量,以推荐在全关节置换术中广泛使用TXA.试验注册我们进行了文献选择，资格标准评估，2023年3月16日在Prospero（CRD42023405387）注册的研究计划的数据提取和分析。
