High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

碩士 === 國立陽明大學 === 護理學系 === 107 === Degenerative arthritis is considered to be an inevitable disease with aging. Knee replacement can solve the pain and activity-restricted symptoms caused by knee joint degeneration, but there will be a lot of bleeding during the total knee arthroplasty (TKA) and blo...

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Main Authors: Hsiao-Chuan Lin, 林小絹
Other Authors: Teh-Fu Hsu
Format: Others
Language:zh-TW
Published: 2019
Online Access:http://ndltd.ncl.edu.tw/handle/7yu526
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spelling ndltd-TW-107YM0055630102019-11-12T05:21:18Z http://ndltd.ncl.edu.tw/handle/7yu526 High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 行全膝關節置換術病人使用高劑量傳明酸(tranexamic acid)降低輸血率及總出血量之探討— 系統性文獻回顧及統合分析 Hsiao-Chuan Lin 林小絹 碩士 國立陽明大學 護理學系 107 Degenerative arthritis is considered to be an inevitable disease with aging. Knee replacement can solve the pain and activity-restricted symptoms caused by knee joint degeneration, but there will be a lot of bleeding during the total knee arthroplasty (TKA) and blood transfusion is needed. However, bleeding and blood transfusions may present some potential risks. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. In recent years, studies have suggested using more than 2g of high-dose TXA, which is more effective in controlling bleeding after TKA. There is no comprehensive systematic review to compare the clinical efficacy of high-dose and low-dose TXA in controlling bleeding after TKA. The purpose of this study was to use a systematic review of the literature to investigate patients undergoing TKA with high or low doses of TXA for blood transfusion rates, total blood loss, total drain output, maximum hemoglobin (Hb) drop, and the incidence of deep vein thrombosis. We conducted a systematic search of PubMed, EBSCO (Medline, CINAHL, Academic search complete-ACS), Embase, Cochrane Library Central Register of Controlled Trials, Taiwan Journal Paper Index System, National Digital Library of Theses and Dissertations in Taiwan and Chinese Electronic Periodical Services (CEPS) for English and Chinese language studies and subsequently by searching the bibliographies of all relevant retrieved articles that were published before October 31, 2018. The following search terms were used on combination with Boolean operators AND or OR: “tranexamic acid” AND “total knee arthroplasty“ OR “total knee replacement“ OR “knee replacement arthroplasties“ OR “knee prosthesis“. By appraising the methodological quality, 21 randomized control trials that had been published between 2010 and 2017 were used for this meta-analysis. Totally there are 1249 patients in high dose TXA group and 920 in low dose group. In this study, there was no significant difference in terms of reducing the number of patients transfused when comparing high dose TXA group with low dose TXA group (RR: 0.74, 95% CI: 0.52 to 1.07, p= 0.11, I2= 0%), but the high doses of TXA significantly reduces total blood loss (MD: -115.12, 95% CI: -168.81 to -61.42, p< 0.001, I2= 81%), total drain output (MD: -51.31, 95% CI: -81.75 to -20.87, p= 0.001, I2= 91%) and maximum Hb drop (MD: -0.43, 95% CI: -0.80 to -0.05, p= 0.02, I2= 94%), then without an apparent increase in thromboembolic complication (RR: 0.54, 95% CI: 0.26 to 1.10, p= 0.09, I2= 0%). A single injection of high dose TXA compared with low dose TXA, cannot effectively reduce blood transfusion rate, total drain output (MD: -18.03, 95% CI: -61.09 to 25.04, p= 0.41, I2= 94%), and maximum Hb drop (MD: 0.12, 95% CI: -0.18 to 0.42, p= 0.44, I2= 55%), however, the commutative high-dose TXA from three consecutive injections can effectively reduce the blood transfusion rate compared with low-dose TXA (RR: 0.40, 95% CI: 0.16 to 0.99, p= 0.05, I2 = 0%) ). Current meta-analysis evidence suggests that the use of intravenous or combined intravenous and local injections to accumulate higher doses of TXA can reduce blood transfusion rate, total blood loss, total drainage output, and hemoglobin decline. Considering the pharmacokinetics of TXA, we recommend that the first dose of TXA was administered before surgery, a second locally injected dose before wound closure, or 1-2 intravenous doses at an interval of three hours. Teh-Fu Hsu 徐德福 2019 學位論文 ; thesis 165 zh-TW
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description 碩士 === 國立陽明大學 === 護理學系 === 107 === Degenerative arthritis is considered to be an inevitable disease with aging. Knee replacement can solve the pain and activity-restricted symptoms caused by knee joint degeneration, but there will be a lot of bleeding during the total knee arthroplasty (TKA) and blood transfusion is needed. However, bleeding and blood transfusions may present some potential risks. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. In recent years, studies have suggested using more than 2g of high-dose TXA, which is more effective in controlling bleeding after TKA. There is no comprehensive systematic review to compare the clinical efficacy of high-dose and low-dose TXA in controlling bleeding after TKA. The purpose of this study was to use a systematic review of the literature to investigate patients undergoing TKA with high or low doses of TXA for blood transfusion rates, total blood loss, total drain output, maximum hemoglobin (Hb) drop, and the incidence of deep vein thrombosis. We conducted a systematic search of PubMed, EBSCO (Medline, CINAHL, Academic search complete-ACS), Embase, Cochrane Library Central Register of Controlled Trials, Taiwan Journal Paper Index System, National Digital Library of Theses and Dissertations in Taiwan and Chinese Electronic Periodical Services (CEPS) for English and Chinese language studies and subsequently by searching the bibliographies of all relevant retrieved articles that were published before October 31, 2018. The following search terms were used on combination with Boolean operators AND or OR: “tranexamic acid” AND “total knee arthroplasty“ OR “total knee replacement“ OR “knee replacement arthroplasties“ OR “knee prosthesis“. By appraising the methodological quality, 21 randomized control trials that had been published between 2010 and 2017 were used for this meta-analysis. Totally there are 1249 patients in high dose TXA group and 920 in low dose group. In this study, there was no significant difference in terms of reducing the number of patients transfused when comparing high dose TXA group with low dose TXA group (RR: 0.74, 95% CI: 0.52 to 1.07, p= 0.11, I2= 0%), but the high doses of TXA significantly reduces total blood loss (MD: -115.12, 95% CI: -168.81 to -61.42, p< 0.001, I2= 81%), total drain output (MD: -51.31, 95% CI: -81.75 to -20.87, p= 0.001, I2= 91%) and maximum Hb drop (MD: -0.43, 95% CI: -0.80 to -0.05, p= 0.02, I2= 94%), then without an apparent increase in thromboembolic complication (RR: 0.54, 95% CI: 0.26 to 1.10, p= 0.09, I2= 0%). A single injection of high dose TXA compared with low dose TXA, cannot effectively reduce blood transfusion rate, total drain output (MD: -18.03, 95% CI: -61.09 to 25.04, p= 0.41, I2= 94%), and maximum Hb drop (MD: 0.12, 95% CI: -0.18 to 0.42, p= 0.44, I2= 55%), however, the commutative high-dose TXA from three consecutive injections can effectively reduce the blood transfusion rate compared with low-dose TXA (RR: 0.40, 95% CI: 0.16 to 0.99, p= 0.05, I2 = 0%) ). Current meta-analysis evidence suggests that the use of intravenous or combined intravenous and local injections to accumulate higher doses of TXA can reduce blood transfusion rate, total blood loss, total drainage output, and hemoglobin decline. Considering the pharmacokinetics of TXA, we recommend that the first dose of TXA was administered before surgery, a second locally injected dose before wound closure, or 1-2 intravenous doses at an interval of three hours.
author2 Teh-Fu Hsu
author_facet Teh-Fu Hsu
Hsiao-Chuan Lin
林小絹
author Hsiao-Chuan Lin
林小絹
spellingShingle Hsiao-Chuan Lin
林小絹
High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
author_sort Hsiao-Chuan Lin
title High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_short High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_fullStr High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed High Dose of Tranexamic Acid for Reducing Transfusion Rate and Total Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_sort high dose of tranexamic acid for reducing transfusion rate and total blood loss in patients undergoing total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials
publishDate 2019
url http://ndltd.ncl.edu.tw/handle/7yu526
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