Tranexamic acid in total knee replacement

British Editorial Society of Bone & Joint Surgery - Tập 93-B Số 12 - Trang 1577-1585 - 2011
Sattar Alshryda1, Praveen Sarda2, Mohamed Sukeik3, A. V. F. Nargol2, John Blenkinsopp2, James Mason4
1The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
2University Hospital of North Tees and Hartlepool, Hardwick Road, Stockton-On-Tees TS19 8PE, UK.
3University College London Hospital, 235 Euston Road, London NW1 2BU, UK
4Durham University, Wolfson Research Institute, University Boulevard, Stockton-On-Tees TS17 6BH, UK.

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.

10.1213/00000539-199704000-00026

10.1016/S0002-9610(99)80054-3

10.1056/NEJM199606273342601

10.1093/bja/aeh290

Henry DA, Carless PA, Moxey AJ, et al.Cochrane Database Syst Rev2007;4:CD001886.

10.1097/00000542-200611000-00026

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

10.1016/S0049-3848(97)00004-2

10.1080/000164700317411834

10.1080/17453670510045444

10.1177/0310057X0303100507

10.1097/00000539-200107000-00018

10.1046/j.1537-2995.2001.41101285.x

10.1213/01.ANE.0000136770.75805.19

10.2106/JBJS.I.01518

Zohar E, 1999, Anesth Analg, 89, 1382, 10.1213/00000539-199912000-00010

10.1016/S0952-8180(01)00319-1

10.1093/bja/aeg111

10.1007/s004029900132

10.1302/0301-620X.89B3.17565

10.1111/j.1537-2995.2007.01564.x

10.1302/0301-620X.78B3.0780434

10.1093/bja/ael057

10.1213/00000539-200103000-00041

10.1093/bja/74.5.534

10.1093/bja/83.4.596

10.1016/j.knee.2005.11.001

10.1302/0301-620X.83B5.0830702

10.1034/j.1399-6576.2002.461007.x

10.1016/S0895-4356(01)00377-8

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

10.1302/0301-620X.93B1.24984

10.1016/j.thromres.2008.09.015

10.1111/j.1537-2995.2005.00204.x

Zhang Y, 2009, Chinese Journal of Orthopaedics, 29, 524

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British Editorial Society of Bone & Joint Surgery

Tập 93-B Số 12

1577-1585

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