| Objective(1) To explore the effectiveness and safety of the use of tranexamic acid(TXA)in total knee arthroplasty(TKA).(2) To investigate the efficacy of repeated use of tranexamic acidon blood loss and thrombosis in total knee arthroplasty.Method(1 ) The criteria for inclusion and exclusion were formulated,with witch the following databases were searched,including PubMed,EBSCO,The Cochrane Library,WanFang database and China National Knowledge Infrastructure(CNKI) from Jan. 2000 to Oct.2015.meta-analysis for screening and quality estimated were calculated with Review Manager 5.2.(2 ) 75 patients incorporated into the test were randomly divided into three groups,25 cases in each group .Patients received 15mg/kg TXA by fast intravenous infusion before tourniquet release in first group(single dose group); patients in second group received two doses of 15mg/kg TXA before tourniquet release and 3 hours postoperation(3h after operation group); patients in third group received two doses of 15mg/kg TXA before tourniquet release and 6 hours postoperation(6h after operation group).The postoperative blood loss via drainage(24 hoursafter the operation),the total blood loss,the hidden blood loss,fibrinogen (FIB ) ,prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer,the postoperative hemoglobin concentration at different times and the numher of patients need blood transfusion were recorded. All patients were observed for detecting deep vein thrombosis(DVT)by the color doppler ultrasonography,and the symptomatic DVT and pulmonary embolism(PE)were observed within 120 days postoperation.Result(1) 18 eligible studies involving 1,576 participants(832 TXA and 744 control)were included in our meta analysis. TXA significantly reduced the total blood loss(WMD=-370.52,95%CI[-398-09, -342.96],P < 0.00001), transfusion unit(WMD=-1.30,95%CI[-1.38,-1.22],P < 0.00001),and the proportion of patients requiring blood transfusion (RR=0.55,95%CI [0.49, 0.63],P <0.00001), without rising the risk of deep venous thrombosis (RR=1.07,95%CI [0.58,1.99],Z=0.22,P =0.83)and pulmonary embolism(RR=0.66,95%CI [0.11, 3.87],Z=0.46,P =0.64) compared with the control group.(2) The blood loss via drainage and total blood loss were significantly less in the 3h after operation group(115.76±48.49ml,713.5±198.7ml) and 6h after operation group(128.56±44.45ml,731.3±187.3ml) compared with the single dose group(305.00±76.88ml,921.8±203.1ml); there was no differences about the hidden blood loss among the three groups;The hemoglobin concentration was significantly higher in the 3h after operation group and 6h after operation group than in the single dose group in hour 24,72 and 120 postoperation. There were no significant differences in the levels of fibrinogen,prothrombin time,activated partial thromboplastin time and D-dimmer between two groups (P>0.05). And no deep vein thrombosis was found 120 days after operation.Conclusion(1) Tranexamic acid is effective in reducing total blood loss, blood transfusion and transfusion rate of total knee arthroplasty. in the meantime it is safety due to not increasing the incidence of postoperative deep vein thrombosis and pulmonary embolism.(2) During and after the TKA,it was efficiency and safety that repeated use of TXA can significantly decrease blood loss without increasing risk for venous thrombosis. The results were similar effect to the decrease of blood loss after TKA in the 3h after operation group and 6h after operation group. |
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