Meta-analysis of the efficacy and safety of tranexamic acid for hemostasis in cancer patients before and during surgery

QI Huihong; CHU Zhijun; FU Lianhao; JIAO Wanli

doi:10.6039/j.issn.1001-0408.2023.14.18

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Meta-analysis of the efficacy and safety of tranexamic acid for hemostasis in cancer patients before and during surgery

更新时间：2023-07-24

- Meta-analysis of the efficacy and safety of tranexamic acid for hemostasis in cancer patients before and during surgery
- ZHONGGUO YAOFANG Vol. 34, Issue 14, Pages: 1755-1760(2023)
- 作者机构：
  
  唐山市工人医院药学部，河北唐山　063000
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.14.18
  CLC： R973+.1
- Published：30 July 2023，
  
  Received：12 October 2022，
  
  Revised：14 June 2023，
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齐会红,褚智君,付连浩等.肿瘤患者术前术中使用氨甲环酸止血有效性和安全性的Meta分析 ^Δ[J].中国药房,2023,34(14):1755-1760.

QI Huihong,CHU Zhijun,FU Lianhao,et al.Meta-analysis of the efficacy and safety of tranexamic acid for hemostasis in cancer patients before and during surgery[J].ZHONGGUO YAOFANG,2023,34(14):1755-1760.
齐会红,褚智君,付连浩等.肿瘤患者术前术中使用氨甲环酸止血有效性和安全性的Meta分析 ^Δ[J].中国药房,2023,34(14):1755-1760. DOI： 10.6039/j.issn.1001-0408.2023.14.18.

QI Huihong,CHU Zhijun,FU Lianhao,et al.Meta-analysis of the efficacy and safety of tranexamic acid for hemostasis in cancer patients before and during surgery[J].ZHONGGUO YAOFANG,2023,34(14):1755-1760. DOI： 10.6039/j.issn.1001-0408.2023.14.18.

摘要

目的

系统评价肿瘤患者术前术中使用氨甲环酸（TXA）止血的有效性和安全性，为临床用药提供循证依据。

方法

计算机检索PubMed、Embase、the Cochrane Library、中国知网、维普网和万方数据，检索氨甲环酸（试验组）对比0.9%氯化钠注射液、乳酸钠林格氏液、复方电解质溶液或安慰剂（对照组）用于肿瘤患者手术的随机对照试验（RCT），检索时限均为建库起至2022年6月9日。筛选文献、提取数据，采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具对纳入文献进行质量评价后，采用RevMan 5.3软件进行Meta分析或描述性分析，并进行敏感性分析和发表偏倚分析。

结果

共纳入22项RCT，合计2 032例患者。Meta分析结果显示，试验组患者的输血率[RR＝0.59，95%CI（0.50，0.69），

＜0.000 01]，红细胞悬液输注量[MD＝－0.53，95%CI（－0.92，－0.14），

＝0.007]均显著低于对照组；两组患者的血栓事件发生率[RR＝0.44，95%CI（0.16，1.17），

＝0.10]、术后病死率[RR＝1.27，95%CI（0.32，5.08），

＝0.73]比较，差异均无统计学意义。描述性分析结果显示，两组患者的总失血量和术后引流量结果存在争议。敏感性分析结果显示，本研究所得结果稳健。发表偏倚分析结果显示，本研究存在发表偏倚的可能性较小。

结论

TXA可显著降低肿瘤手术患者输血率，减少红细胞悬液输注量，且未增加血栓事件发生率和术后病死率。

Abstract

OBJECTIVE

To systematically review the efficacy and safety of tranexamic acid （TXA） for hemostasis in cancer patients before and during surgery， and to provide evidence-based reference for clinical drug use.

METHODS

Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP and Wanfang databases， randomized controlled trials （RCTs） about tranexamic acid （trial group） versus 0.9% Sodium chloride injection， Lactated Ringer’s solution， Compound electrolyte solution or placebo （control group） for cancer surgery were electronically searched from the inception to June 9， 2022. After literature screening and data extraction， the quality of included RCTs were evaluated by bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. RevMan 5.3 software was used for meta-analysis or descriptive analysis， sensitivity analysis and publication bias analysis.

RESULTS

A total of 2 032 patients in 22 RCTs were included for meta-analysis. Results of meta-analysis showed that the blood transfusion rate [RR＝0.59， 95%CI （0.50， 0.69），

＜0.000 01] and the volume of erythrocyte suspension infusion [MD＝－0.53， 95%CI （－0.92，－0.14），

＝0.007] in trial group were significantly lower than control group； there was no statistical significance in the incidence of thromboembolic events [RR＝0.44， 95%CI （0.16， 1.17），

＝0.10] or post-operative mortality [RR＝1.27， 95%CI（0.32，5.08），

＝0.73] between two groups. Results of descriptive analysis showed that the total blood loss and postoperative drainage volume were still controversial between two groups. The results of sensitivity analysis showed that the results were basically stable. The results of publication bias analysis showed that there was little possibility of publication bias in this study.

CONCLUSIONS

TXA can significantly decrease the blood transfusion， reduce the volume of erythrocyte suspension infusion， whereas does not increase the incidence of thromboembolic events and post-operative mortality in cancer surgery.

关键词

氨甲环酸肿瘤患者有效性安全性血栓事件

Keywords

cancer patientsefficacysafetythromboembolic events

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