Akromion Special Hospital for Orthopedic Surgery, Krapinske Toplice, Croatia.
Transfusion. 2014 Jan;54(1):31-41. doi: 10.1111/trf.12224. Epub 2013 Apr 25.
Postoperatively shed blood salvage is commonly used to reduce allogenic blood transfusion in patients undergoing total hip (THA) and knee arthroplasty (TKA). Autologous blood retransfusion is not devoid of risk. We hypothesized that adding tranexamic acid (TXA) to a restrictive blood transfusion protocol would reduce the need for postoperative autologous blood retransfusion in primary knee and hip arthroplasty.
Ninety-eight adult patients undergoing primary THA or TKA were randomly assigned to receive an intraoperative intravenous loading dose of 1.0 g of TXA followed by another 1.0-g dose 3 hours later (TXA group) or a matching volume 0.9% saline placebo (control group). A postoperatively shed autologous blood recovery system was used in all patients and the minimum reinfusion volume set at 250 mL. Red blood cells were transfused if hemoglobin level was less than 8 or if 8 to 10 g/dL with symptoms of anemia.
The proportion of patients receiving autologous blood reinfusion was significantly lower in the TXA group (5/49) compared to placebo (42/49) with an absolute difference of -75.5% (adjusted relative risk, 0.005), and none of the patients in the TXA group received more than 400 mL retransfused. Median total external blood loss during the first 24 hours was lower in the TXA group, 320 mL (range, 80-930 mL), compared to 970 mL (range, 100-2600 mL) in the placebo group (p < 0.001). There were no significant differences in homologous blood transfusions and hematologic variables between groups. Treatment differences were consistent by size and significance when the analysis was repeated separately in patients undergoing TKA or THA.
Addition of TXA to a restrictive transfusion protocol makes the use of a postoperative blood salvage system in patients undergoing primary hip and knee arthroplasty unnecessary.
在接受全髋关节置换术（THA）和膝关节置换术（TKA）的患者中，术后回收血液是常用的减少异体输血的方法。自体输血并非没有风险。我们假设，在限制输血方案中添加氨甲环酸（TXA）可减少初次膝关节和髋关节置换术后自体血液回输的需求。
98 例接受初次 THA 或 TKA 的成年患者随机分为接受术中静脉负荷剂量 1.0 g TXA，然后在 3 小时后再给予另 1.0 g TXA（TXA 组）或匹配体积的 0.9%生理盐水安慰剂（对照组）。所有患者均使用术后回收的自体血液回收系统，最低回输量设定为 250 mL。如果血红蛋白水平低于 8 g/dL或血红蛋白 8 至 10 g/dL 伴有贫血症状，则输注红细胞。
与安慰剂组（42/49）相比，TXA 组（5/49）接受自体血液再输注的患者比例显著降低，绝对差异为-75.5%（调整后的相对风险，0.005），且 TXA 组无患者接受超过 400 mL 的再输注。TXA 组术后 24 小时内总外出血中位数较低，为 320 mL（范围，80-930 mL），而安慰剂组为 970 mL（范围，100-2600 mL）（p < 0.001）。两组间同种异体输血和血液学变量无显著差异。当分别在接受 TKA 或 THA 的患者中重复分析时，治疗差异在大小和显著性方面均一致。
在限制输血方案中添加 TXA 可使初次髋关节和膝关节置换术患者无需使用术后血液回收系统。
