Bidolegui Fernando, Arce Guillermo, Lugones Alfonso, Pereira Sebastián, Vindver Gabriel
Department of Orthopedic Surgery, Hospital Sirio Libanés, Ciudad Autonoma de Buenos Aires, Argentina.
Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Ciudad Autonoma de Buenos Aires, Argentina.
Open Orthop J. 2014 Jul 11;8:250-4. doi: 10.2174/1874325001408010250. eCollection 2014.
Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and to decrease transfusion rates in patients undergoing TKA. Tranexamic acid is an antifibrinolytic agent with known efficacy for achieving these goals. Currently, many surgeons are performing TKA without the use of tourniquet. Consequently, the aim of the study is to evaluate whether tranexamic acid reduces blood loss during and after TKA without the adjunctive use of above-the-knee tourniquet.
We performed a prospective randomized controlled trial (1:1 fashion) on the use of tranexamic acid versus placebo in 50 patients undergoing TKA (without tourniquet). The treatment group received two (preoperative and postoperative) 15 mg/kg doses. The primary endpoint was blood transfusion rate. We collected data about demographic and procedural characteristics, hemoglobin and hematocrit values, drain blood loss at 24 hours as well as adverse events.
There were no transfusions in the treatment group, whereas 32% of the control group required transfusion (p<0.01). The treatment group had higher hematocrit and hemoglobin levels at 24, 48 and 72 hours after surgery (all p<0.01) and lower drain loss at 24hours (363.4±141 vs 626±260ml, p=<0,001). There were no in-hospital or six-month thromboembolic complications.
A double-dose of tranexamic acid was safe and effective, reducing blood loss and preventing the need of blood transfusion in patients undergoing TKA without above-the-need tourniquet.
全膝关节置换术（TKA）期间及术后失血可导致严重的发病率，并需要输血。有几种方法可将接受TKA患者的失血量降至最低并降低输血率。氨甲环酸是一种抗纤维蛋白溶解剂，已知对实现这些目标有效。目前，许多外科医生在进行TKA时不使用止血带。因此，本研究的目的是评估氨甲环酸在不辅助使用大腿止血带的情况下是否能减少TKA期间及术后的失血。
我们对50例接受TKA（不使用止血带）的患者进行了一项前瞻性随机对照试验（1:1方式），比较氨甲环酸与安慰剂的使用情况。治疗组接受两次（术前和术后）15mg/kg剂量。主要终点是输血率。我们收集了有关人口统计学和手术特征、血红蛋白和血细胞比容值、24小时引流失血量以及不良事件的数据。
治疗组无输血情况，而对照组32%的患者需要输血（p<0.01）。治疗组在术后24、48和72小时的血细胞比容和血红蛋白水平较高（均p<0.01），24小时引流失血量较低（363.4±141 vs 626±260ml，p=0.001）。无院内或六个月血栓栓塞并发症。
双倍剂量的氨甲环酸安全有效，可减少不使用大腿止血带的TKA患者的失血并避免输血需求。
