Churchill Jessica L, Puca Kathleen E, Meyer Elizabeth S, Carleton Matthew C, Truchan Susan L, Anderson Michael J
Eastern Virginia Medical School, Norfolk, Virginia.
Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin.
J Arthroplasty. 2016 Dec;31(12):2795-2799.e1. doi: 10.1016/j.arth.2016.05.011. Epub 2016 May 13.
Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA.
Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network.
In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery.
Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery.
在全髋关节置换术（THA）中使用抗纤溶药物有充分的依据；然而，大多数研究使用的是氨甲环酸（TXA），而使用类似抗纤溶药物ε-氨基己酸（EACA）的研究较少。本研究比较了术中输注EACA和TXA在降低THA术后输血率方面的疗效及每次手术的成本。
对我们医疗网络内5家医院2012年4月至2014年12月期间的1799例初次单侧THA病例进行回顾性病历审查。
在我们的队列中，711例接受了EACA，445例接受了TXA，643例（对照组）未接受抗纤溶药物。与对照组相比，两个抗纤溶药物组接受红细胞（RBC）输血的患者明显减少（EACA组为6.8%[P <.0001]，TXA组为9.7%[P <.0001]，而对照组为24.7%）。EACA组和TXA组患者的平均RBC单位数相似（分别为0.11单位/患者和0.15单位/患者），且均显著低于对照组（0.48单位/患者，P <.0001）。EACA组和TXA组之间患者的平均RBC单位数及输血患者百分比无显著差异（P =.144，P =.074）。逻辑回归显示，在调整年龄、性别、更高的疾病严重程度水平、入院血红蛋白、主刀医生和医院后，EACA和TXA之间无差异。EACA的药物采购成本平均每次手术为2.70美元，而TXA为每次手术39.58美元。
术中使用抗纤溶药物可显著降低术后输血需求。在我们机构，在THA中EACA在降低输血率方面与TXA相当，但每次手术成本更低。
