Tranexamic acid plus drain-clamping reduces blood loss in total knee arthroplasty: a meta-analysis

doi:10.3969/j.issn.2095-4344.1046

Abstract

Abstract:

BACKGROUND: Clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty still remain uncertain.

OBJECTIVE: To systematically review the clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty.

METHODS: PubMed, EMBASE, The Cochrane Library, CNKI, VIP and WanFang databases were searched for the clinical trials addressing tranexamic acid plus drain-clamping versus other methods in total knee arthroplasty from January 2008 to June 2018. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. The primary measurement outcome was the number of patients with blood transfusion. The secondary outcomes were total blood loss, drainage volume, decrease in hemoglobin, and the incidence of deep venous thrombosis. Changes in these outcomes were analyzed by a meta-analysis on RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) Twelve studies with 1 220 patients were included. (2) Meta-analysis results showed that the number of patients with blood transfusion in the trial group was significantly less than that in the control group [RR=0.35, 95%CI (0.23, 0.52), Z=5.22, P < 0.05]. (3) The total blood loss [MD=-325.45, 95%CI (-445.12, -205.78), Z=5.33, P < 0.05], drainage volume [MD=-269.85, 95%CI (-334.78, -204.93), Z=8.15, P < 0.05], and the decrease in hemoglobin [MD=-0.91, 95%CI (-1.23, -0.58), Z＝5.46, P < 0.05] in the trial group were significantly lower than those in the control group. The incidence of deep venous thrombosis in the trial group was slightly lower than that in the control group [RR＝0.40, 95%CI (0.08, 2.05), Z=1.09, P > 0.05]. (4) These results show that compared with the control group, tranexamic acid plus drain-clamping can significantly reduce perioperative blood loss in total knee arthroplasty. The number and the quality of the included studies are far from perfect, so more high-quality randomized controlled trials are needed to identify the optimal dose of tranexamic acid and the clamping hours.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tranexamic Acid, Arthroplasty, Replacement, Knee, Hemorrhage, Meta-Analysis

CLC Number:

R459.9

Zhang Yan, Kan Quan, Zhang Junwei, Wang Baohua, Ping Shaohua. Tranexamic acid plus drain-clamping reduces blood loss in total knee arthroplasty: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 643-649.

Figures/Tables 5

2.3 Meta分析结果 2.3.1 输血人数试验组与对照组输血人数比较见图4，共纳入10个研究[15-22，24，26]。根据随机效应模型Meta分析结果显示，围术期使用氨甲环酸结合引流管夹闭治疗的患者术后输血人数显著少于对照组，且差异有显著性意义[RR=0.35，95%CI(0.23，0.52)，P < 0.05]。亚组分析结果显示，氨甲环酸结合引流管夹闭组术后输血人数显著少于无处理组[RR=0.33，95%CI(0.16，0.70)，P < 0.05]、单独引流管夹闭组[RR=0.26，95%CI(0.12，0.56)，P < 0.05]及单独氨甲环酸组[RR=0.66，95%CI(0.45，0.96)，P < 0.05]。总体结果表明，与对照组治疗方法相比，围手术期使用氨甲环酸结合引流管夹闭可以显著减少全膝关节置换的术后输血人数。 2.3.2 总失血量试验组与对照组总失血量比较见图5，共纳入9个研究[16-21，24-26]。根据随机效应模型Meta分析结果显示，围手术期使用氨甲环酸结合引流管夹闭治疗的患者总失血量显著低于对照组，且差异有显著性意义[MD=-325.45，95%CI(-445.12，-205.78)，P < 0.05]。亚组分析结果显示，氨甲环酸结合引流管夹闭组总失血量显著低于无处理组[MD=-517.04，95%CI(-754.25，-279.82)，P < 0.05]及单独引流管夹闭组[MD=-304.66，95%CI(-430.87，-178.46)，P < 0.05]，单独氨甲环酸组与试验组相比差异无显著性意义[MD=-59.70，95%CI(-134.96，-15.56)，P > 0.05]。总体结果表明，跟对照组治疗方法相比，围手术期使用氨甲环酸结合引流管夹闭可以显著减少全膝关节置换患者的总失血量。 2.3.3 引流失血量试验组与对照组引流失血量比较见图6，共纳入11个研究[15-16，18-26]。根据随机效应模型Meta分析结果显示，围手术期使用氨甲环酸结合引流管夹闭治疗的患者引流失血量显著低于对照组，且差异有显著性意义[MD=-269.85，95%CI(-334.78，-204.93)，P < 0.05]。亚组分析结果显示，氨甲环酸结合引流管夹闭组引流失血量显著低于无处理组[MD=-337.29，95%CI(-488.81，-185.77)，P < 0.05]、单独引流管夹闭组[MD=-265.98，95%CI(-367.00，-164.97)，P < 0.05]及单独氨甲环酸组[MD=-150.68，95%CI(-215.73，-85.63)，P < 0.05]。总体结果表明，与对照组治疗方法相比，围手术期使用氨甲环酸结合引流管夹闭可以显著减少全膝关节置换患者的引流失血量。 2.3.4 血红蛋白降低量试验组与对照组血红蛋白降低量比较见图7，共纳入6个研究[15，17-21]。根据随机效应模型Meta分析结果显示，围手术期使用氨甲环酸结合引流管夹闭治疗的患者血红蛋白降低量显著低于对照组，且差异有显著性意义[MD=-0.91，95%CI(-1.23，-0.58)，P < 0.05]。亚组分析结果显示，氨甲环酸结合引流管夹闭组血红蛋白降低量显著低于无处理组[MD=-1.50，95%CI(-1.79，-1.21)，P < 0.05]、单独引流管夹闭组[MD=-0.99，95%CI(-1.30，-0.69)，P < 0.05]及单独氨甲环酸组[MD=-0.40，95%CI(-0.60，-0.20)，P < 0.05]。总体结果表明，与对照组治疗方法相比，围手术期使用氨甲环酸结合引流管夹闭可以显著抑制全膝关节置换患者血红蛋白水平的降低。"

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