Vigna-Taglianti Federica, Basso Leonardo, Rolfo Paola, Brambilla Romeo, Vaccari Federica, Lanci Gisella, Russo Roberto
Department of Clinical and Biological Sciences, University of Torino, Regione Gonzole 10, 10043, Orbassano (Torino), Italy,
Eur J Orthop Surg Traumatol. 2014 May;24(4):545-51. doi: 10.1007/s00590-013-1225-y. Epub 2013 Apr 30.
Tranexamic acid (TXA) administered during arthroplasty intervention can prevent blood loss and blood transfusions. The purpose of the present study is to evaluate the benefit of TXA administration on blood transfusion rates in patients undergoing joint arthroplasty, and to perform cost-benefit analysis.
The study population included 100 patients admitted for arthroplasty intervention between 1st June 2008 and 31st October 2008 who did not receive TXA, and 98 patients admitted between 1st June 2009 and 31st October 2009 receiving TXA during the intervention. Blood transfusion was the main outcome. Risk factors for transfusion were evaluated in logistic regression models. Costs of autologous blood donation, TXA administration, autotransfusion and homologous blood transfusion were used to perform a cost-benefit evaluation.
In the multivariate adjusted analysis, high preoperative haemoglobin level and TXA administration were significantly associated with a reduced risk of transfusion. Seventy-five percent of patients not receiving TXA required at least one transfusion versus 40.8% of patients receiving TXA, with a reduction of 45.6%. The mean number of blood units transfused was reduced of 26%. The reduction in transfusions was higher in hip arthroplasty. Among patients receiving TXA, the reduction in Hb level was lower both at days 1 and 2 after the intervention. The mean saving related to TXA administration was of
The administration of TXA during arthroplasty intervention reduces the need of transfusion among patients undertaking arthroplasty interventions and can be considered a cost-effective practice for the National Health System.
在关节置换手术中使用氨甲环酸（TXA）可预防失血和输血。本研究的目的是评估TXA给药对接受关节置换术患者输血率的益处，并进行成本效益分析。
研究人群包括2008年6月1日至2008年10月31日期间因关节置换手术入院且未接受TXA的100例患者，以及2009年6月1日至2009年10月31日期间入院且在手术中接受TXA的98例患者。输血是主要结局。在逻辑回归模型中评估输血的危险因素。使用自体献血、TXA给药、自体输血和异体输血的成本进行成本效益评估。
在多变量调整分析中，术前血红蛋白水平高和使用TXA与输血风险降低显著相关。未接受TXA的患者中有75%至少需要一次输血，而接受TXA的患者中这一比例为40.8%，降低了45.6%。平均输血量减少了26%。髋关节置换术中输血减少更为明显。在接受TXA的患者中，干预后第1天和第2天血红蛋白水平的降低幅度较小。与TXA给药相关的平均节省费用为每位患者<138欧元。
在关节置换手术中使用TXA可减少接受关节置换手术患者的输血需求，可被认为是国家卫生系统具有成本效益的做法。
