Tranexamic acid in total knee replacement
Tóm tắt
We conducted a systematic review and meta-analysis of randomised controlled trials evaluating the effect of tranexamic acid (TXA) upon blood loss and transfusion in primary total knee replacement. The review used the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. A total of 19 trials were eligible: 18 used intravenous administration, one also evaluated oral dosing and one trial evaluated topical use. TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk ratio (RR) 2.56, 95% confidence interval (CI) 2.1 to 3.1, p < 0.001; heterogeneity I2= 75%; 14 trials, 824 patients). Using TXA also reduced total blood loss by a mean of 591 ml (95% CI 536 to 647, p < 0.001; I2= 78%; nine trials, 763 patients). The clinical interpretation of these findings is limited by substantial heterogeneity. However, subgroup analysis of high-dose (> 4 g) TXA showed a plausible consistent reduction in blood transfusion requirements (RR 5.33; 95% CI 2.44 to 11.65, p < 0.001; I2= 0%), a finding that should be confirmed by a further well-designed trial. The current evidence from trials does not support an increased risk of deep-vein thrombosis (13 trials, 801 patients) or pulmonary embolism (18 trials, 971 patients) due to TXA administration.
Từ khóa
Tài liệu tham khảo
No authors listed.National Joint Registry for England and Wales. Summary of annual statistics (England and Wales). http://www.njrcentre.org.uk/njrcentre/Healthcareproviders/Accessingthedata/StatsOnline/NJRStatsOnline/tabid/179/Default.aspx (date last accessed 10 October 2011).
Benoni G, Carlsson A, Petersson C, Fredin HDoes tranexamic acid reduce blood loss in knee arthroplasty?Am J Knee Surg1995;8:88–92.
Henry DA, Carless PA, Moxey AJ, et al.Cochrane Database Syst Rev2007;4:CD001886.
Higgins JPT, Green SCochrane handbook for systematic reviews of interventions 4.2.6, 2006. http://www.cochrane.org/sites/default/files/uploads/Handbook4.2.6Sep2006.pdf (date last accessed 8 August 2011).
Madhok R, Shaw LJ, Elliott J, Gillespie LDBone, Joint and Muscle Trauma Group: about the Cochrane Collaboration (Collaborative Review Groups (CRGs)).Cochrane Database Syst Rev2006;4:MUSKINJ.
Akizuki S, 1997, Bull Hosp Jt Dis, 56, 222
Kakar PN, Gupta N, Govil P, Shah VEfficacy and safety of tranexamic acid in control of bleeding following TKR: a randomized clinical trial.Indian J Anaesth2009;53:667–671.
Zhang F, 2007, Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 21
Zhang Y, 2009, Chinese Journal of Orthopaedics, 29, 524