BMJ：氨甲环酸有助减少手术输血需求 可缓解血荒现象

“血荒”有时会给医疗机构带来麻烦，英国的一项新研究显示，使用止血药——氨甲环酸可显著减少手术的输血需求，这或许有助缓解“血荒”现象。

英国伦敦卫生与热带医学院的研究人员在新一期《英国医学杂志》上发表报告说，他们对氨甲环酸与输血需求之间的关系进行了大量综合分析，并对比手术中使用这种药物与未使用该药的临床表现。结果显示，如果给需要手术的病人使用氨甲环酸，可使他们的输血需求平均降低约三分之一。

研究人员伊恩-罗伯茨说，输血虽有助拯救生命，但输血过程本身存在一些风险，避免或减少输血在有些时候对某些病人来说是不错的选择。

氨甲环酸是一种止血药，接受手术的病人如果摄入这种药，可减少失血量，从而降低输血需求。在安全性方面，这种药已获得很多国家监管机构的使用许可，研究人员迄今没有发现使用该药会增加健康风险。

doi: 10.1136/bmj.e3054
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Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis

Katharine Ker, Phil Edwards, Pablo Perel, Haleema Shakur, Ian Roberts

Objective To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients. Design Systematic review and meta-analysis. Data sources Cochrane central register of controlled trials, Medline, and Embase, from inception to September 2011, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of relevant articles. Study selection Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in surgical patients. Outcome measures of interest were the number of patients receiving a blood transfusion; the number of patients with a thromboembolic event (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism); and the number of deaths. Trials were included irrespective of language or publication status. Results 129 trials, totalling 10 488 patients, carried out between 1972 and 2011 were included. Tranexamic acid reduced the probability of receiving a blood transfusion by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65; P<0.001). This effect remained when the analysis was restricted to trials using adequate allocation concealment (0.68, 0.62 to 0.74; P<0.001). The effect of tranexamic acid on myocardial infarction (0.68, 0.43 to 1.09; P=0.11), stroke (1.14, 0.65 to 2.00; P=0.65), deep vein thrombosis (0.86, 0.53 to 1.39; P=0.54), and pulmonary embolism (0.61, 0.25 to 1.47; P=0.27) was uncertain. Fewer deaths occurred in the tranexamic acid group (0.61, 0.38 to 0.98; P=0.04), although when the analysis was restricted to trials using adequate concealment there was considerable uncertainty (0.67, 0.33 to 1.34; P=0.25). Cumulative meta-analysis showed that reliable evidence that tranexamic acid reduces the need for transfusion has been available for over 10 years. Conclusions Strong evidence that tranexamic acid reduces blood transfusion in surgery has been available for many years. Further trials on the effect of tranexamic acid on blood transfusion are unlikely to add useful new information. However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice.