在心脏手术中联合局部和静脉注射氨甲环酸：真的重要吗？-系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2026-02-01 Epub Date: 2025-12-01 DOI:10.1016/j.ijcha.2025.101848

Paul C. Onyeji , Leo Consoli , Amrinder Kaur , Shivank Dani , Sonise Momplaisir-Onyeji , Felipe S. Passos , Hristo Kirov , Torsten Doenst , Tulio Caldonazo

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引用次数: 0

摘要

背景：心脏手术中静脉注射（IV）和外用氨甲环酸（TXA）的利弊比尚未确定。本研究旨在评估联合方法（静脉注射加局部TXA）是否比单独静脉注射TXA提供更好的出血控制，同时保持可接受的安全性。方法：我们对随机对照试验（rct）和观察性研究进行了系统回顾和荟萃分析，比较了局部和静脉联合给药与单独静脉给药对心脏手术患者的影响。主要终点是累积失血量。次要结局包括全因死亡率、无输血状态和输血血制品数量。所有合并分析均采用随机效应模型。结果共纳入5项研究（4项随机对照试验，1项观察性研究，n = 880）。合并分析显示，与仅iv - TXA策略相比，联合方法显著但适度地减少了总失血量（MD - 39.84, 95% CI - 74.80至- 4.88;p = 0.03; I2 = 39%）。然而，这一益处并没有转化为输血需要量（OR 1.00, 95% CI 0.72至1.37;p = 0.98; I2 = 0%）、血制品使用量（MD - 0.01, 95% CI - 0.04至0.02;p = 0.51; I2 = 0%）或全因死亡率（OR 0.85, 95% CI 0.24至3.08;p = 0.81; I2 = 0%）的显著减少。结论与单纯静脉应用相比，局部和静脉联合应用TXA可减少心脏手术后总失血量。然而，在输血率、血液制品利用率或死亡率方面没有观察到显著差异。

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Combining topical and intravenous tranexamic acid in cardiac surgery: does it really matter? – a systematic review and meta-analysis

Background

The benefit-to-risk ratio of administration of intravenous (IV) and topical tranexamic acid (TXA) together in cardiac surgery has not yet been determined. This study aims to evaluate whether the combined approach (IV plus topical TXA) offers superior bleeding control compared to IV TXA alone, while maintaining an acceptable safety profile.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing combined topical and intravenous TXA administration versus IV TXA alone in patients undergoing cardiac surgery. The primary outcome was cumulative blood loss. Secondary outcomes included all-cause mortality, transfusion-free status, and the number of transfused blood products. A random-effects model was used for all pooled analyses.

Results

We included a total of five studies (four RCTs, one observational; n = 880). Pooled analysis showed that the combined approach significantly, but modest, reduced total blood loss when compared to an IV-only TXA strategy (MD −39.84, 95 %CI −74.80 to −4.88; p = 0.03; I² = 39 %). However, this benefit did not translate into a significant reduction in transfusion requirements (OR 1.00, 95 %CI 0.72 to 1.37; p = 0.98; I² = 0 %), volume of blood products used (MD −0.01, 95 %CI −0.04 to 0.02; p = 0.51; I² = 0 %), or all-cause mortality (OR 0.85, 95 %CI 0.24 to 3.08; p = 0.81; I² = 0 %).

Conclusion

Combined topical and IV TXA application is associated with reduced total blood loss after cardiac surgery compared to an IV-only approach. However, no significant differences were observed in transfusion rates, blood product utilization, or mortality.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.