Guzel Y, Gurcan O T, Golge U H, Dulgeroglu T C, Metineren H
Ordu University Medical School, Turkey.
J Orthop Surg (Hong Kong). 2016 Aug;24(2):179-82. doi: 10.1177/1602400212.
To compare the use of topical tranexamic acid (TXA) with postoperative autologous transfusion (PAT) in terms of blood loss, need for allogeneic blood transfusion, and cost-effectiveness.
Records of 25 men and 125 women (mean age, 67 years) who underwent primary unilateral total knee arthroplasty (TKA) and were randomised to the PAT group (n=50), topical TXA group (n=50), or routine drainage group (control) [n=50] were reviewed. Pre- and post-operative haemoglobin level, total postoperative drainage volume, and the need for allogeneic blood transfusion were recorded.
The 3 groups were comparable in terms of age, gender, and preoperative haemoglobin level. The total postoperative drainage volume was lower in the TXA group than the PAT or routine drainage groups (174.48 vs. 735 vs. 760 ml, p<0.001). The postoperative haemoglobin level was lower in the routine drainage group than the PAT or TXA groups on day 1 (11.67 vs. 12.33 vs. 12.40 g/dl, p<0.001) and day 3 (9.9 vs. 10.7 vs. 11.14 g/dl, p<0.001). The number of patients who received allogeneic blood transfusion was higher in the routine drainage group (12 and 4 patients received 1 and 2 units of blood, respectively) than the PAT group (4 patients received 1 unit of blood) or the TXA group (none required transfusion) [p<0.001], and the respective total transfusion cost was $1200, $240, and $0. The total cost was lowest in the TXA group followed by the routine drainage group and PAT group ($200 vs. $1200 vs. $12 390). No patient developed acute infection, deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke.
Compared with PAT, topical TXA was more cost-effective and resulted in less total postoperative drainage volume and less need for allogeneic blood transfusion.
比较局部应用氨甲环酸（TXA）与术后自体输血（PAT）在失血、异体输血需求及成本效益方面的差异。
回顾了25名男性和125名女性（平均年龄67岁）的记录，这些患者接受了初次单侧全膝关节置换术（TKA），并被随机分为PAT组（n = 50）、局部TXA组（n = 50）或常规引流组（对照组）[n = 50]。记录术前和术后血红蛋白水平、术后总引流量以及异体输血需求。
三组在年龄、性别和术前血红蛋白水平方面具有可比性。TXA组术后总引流量低于PAT组或常规引流组（174.48 vs. 735 vs. 760 ml，p < 0.001）。常规引流组术后第1天（11.67 vs. 12.33 vs. 12.40 g/dl，p < 0.001）和第3天（9.9 vs. 10.7 vs. 11.14 g/dl，p < 0.001）的血红蛋白水平低于PAT组或TXA组。常规引流组接受异体输血的患者数量高于PAT组（4名患者接受1单位血液）或TXA组（无患者需要输血）[p < 0.001]，相应的总输血成本分别为1200美元、240美元和0美元。总成本在TXA组最低，其次是常规引流组和PAT组（200美元 vs. 1200美元 vs. 12390美元）。没有患者发生急性感染、深静脉血栓形成、肺栓塞、心肌梗死或中风。
与PAT相比，局部应用TXA更具成本效益，术后总引流量更少，异体输血需求更少。
