From the Department of Anesthesiology (S.Sigaut, B.T., S. Schlumberger, M.F.), Clinical Research Unit (J.-F.D.), Hôpital Foch, Suresnes, France; Department of Anesthesiology and Critical Care 2 (A.O.), University Hospital, Bordeaux, France; Department of Anesthesiology, Centre Chirurgical Marie Lannelongue (R.C.), Le Plessis-Robinson, France; Department of Anesthesiology and Critical Care (C.T.), University Hospital, Besançon, France; and Laboratory of Pharmacology and Toxicology (S.G.-D.), Centre Hospitalier Universitaire Raymond Poincaré, Garches, France.
Anesthesiology. 2014 Mar;120(3):590-600. doi: 10.1097/ALN.0b013e3182a443e8.
The optimal dose of tranexamic acid (TA) is still an issue. The authors compared two doses of TA during cardiac surgery in a multicenter, double-blinded, randomized study.
Patients were stratified according to transfusion risk, then randomized to two TA doses: 10 mg/kg bolus followed by 1 mg·kg·h infusion (low dose) until the end of surgery or 30 mg/kg bolus followed by 16 mg·kg·h infusion (high dose). The primary endpoint was the incidence of blood product transfusion up to day 7. Secondary ones were incidences of transfusion for each type of blood product and amounts transfused, blood loss, repeat surgery, TA-related adverse events, and mortality.
The low-dose group comprised 284 patients and the high-dose one 285. The primary endpoint was not significantly different between TA doses (63% for low dose vs. 60% for high dose; P = 0.3). With the high dose, a lower incidence of frozen plasma (18 vs. 26%; P = 0.03) and platelet concentrate (15 vs. 23%; P = 0.02) transfusions, lower amounts of blood products (2.5 ± 0.38 vs. 4.1 ± 0.39; P = 0.02), fresh frozen plasma (0.49 ± 0.14 vs.1.07 ± 0.14; P = 0.02), and platelet concentrates transfused (0.50 ± 0.15 vs. 1.13 ± 0.15; P = 0.02), lower blood loss (590 ± 50.4 vs. 820 ± 50.7; P = 0.01), and less repeat surgery (2.5 vs. 6%; P = 0.01) were observed. These results are more marked in patients with a high risk for transfusion.
A high dose of TA does not reduce incidence of blood product transfusion up to day 7, but is more effective than a low dose to decrease transfusion needs, blood loss, and repeat surgery.
氨甲环酸（TA）的最佳剂量仍存在争议。作者在一项多中心、双盲、随机研究中比较了心脏手术中两种 TA 剂量。
根据输血风险对患者进行分层，然后随机分为两组 TA 剂量：10 mg/kg 推注，然后 1 mg·kg·h 输注（低剂量）至手术结束，或 30 mg/kg 推注，然后 16 mg·kg·h 输注（高剂量）。主要终点是至第 7 天的输血发生率。次要终点是每种血液制品的输血发生率和输血量、失血、再次手术、与 TA 相关的不良事件和死亡率。
低剂量组 284 例，高剂量组 285 例。两组 TA 剂量的主要终点无显著差异（低剂量组 63%，高剂量组 60%；P = 0.3）。高剂量组，更少的冰冻血浆（18% vs. 26%；P = 0.03）和血小板浓缩物（15% vs. 23%；P = 0.02）输血，更少的血液制品（2.5 ± 0.38 vs. 4.1 ± 0.39；P = 0.02），新鲜冰冻血浆（0.49 ± 0.14 vs.1.07 ± 0.14；P = 0.02）和血小板浓缩物（0.50 ± 0.15 vs. 1.13 ± 0.15；P = 0.02）输血，更少的失血（590 ± 50.4 vs. 820 ± 50.7；P = 0.01）和更少的再次手术（2.5% vs. 6%；P = 0.01）。这些结果在输血风险高的患者中更为明显。
高剂量 TA 并不能降低至第 7 天的输血发生率，但与低剂量相比，更有效地减少输血需求、失血和再次手术。
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