Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2017 Nov;32(11):3445-3448. doi: 10.1016/j.arth.2017.05.040. Epub 2017 May 31.
Fibrin sealants are topical agents used to reduce perioperative blood loss; however, their efficacy in total hip arthroplasty (THA) remains uncertain. The purpose of this study was to determine if a fibrin sealant containing aprotinin as an antifibrinolytic agent, TISSEEL (Baxter, Deerfield, IL), reduces postoperative blood loss and transfusion during THA when compared with intravenous (IV) tranexamic acid (TXA) and control groups.
Three retrospective uniform cohorts of primary THA procedures were identified, from a prospectively maintained database: 1 group who received TISSEEL, 1 group who received 1 g IV TXA, and 1 group who received neither (control). There were 80 patients in each group. Outcome measures included the lowest measured hemoglobin during postoperative hospitalization, greatest decrease in hemoglobin from preoperative to postoperative values, and blood transfusion rates.
The minimum postoperative hemoglobin level was significantly lower for TISSEEL patients compared with that of IV TXA patients (P = .021) and no different when compared with that of control patients (P = .134). Patients receiving fibrin sealant had a greater hemoglobin level decrease compared with that of IV TXA (P = .029) and control (P = .036). Postoperative transfusion rates were no different for the group receiving TISSEEL compared with those of control (P = .375) and were statistically greater when compared with those of IV TXA (P = .002).
TISSEEL fibrin sealant does not reduce postoperative blood loss or transfusions; however, IV TXA reduced postoperative transfusions compared with TISSEEL and control. Therefore, TXA is recommended to reduce perioperative blood loss, while, utilization of a fibrin sealant requires further refinements before being adopted for routine use in THA.
纤维蛋白粘合剂是一种用于减少围手术期失血的局部制剂；然而，它们在全髋关节置换术（THA）中的疗效仍不确定。本研究旨在确定一种含有抑肽酶作为抗纤维蛋白溶解剂的纤维蛋白粘合剂 TISSEEL（百特，迪尔菲尔德，IL）是否可以减少与静脉内（IV）氨甲环酸（TXA）和对照组相比，THA 术后失血和输血。
从一个前瞻性维护的数据库中确定了三组接受原发性 THA 手术的回顾性统一队列：1 组接受 TISSEEL，1 组接受 1 g IV TXA，1 组未接受治疗（对照组）。每组有 80 名患者。观察指标包括术后住院期间最低测量的血红蛋白值、术前至术后血红蛋白值的最大下降值以及输血率。
与 IV TXA 组相比，接受纤维蛋白粘合剂治疗的患者术后最低血红蛋白水平显著降低（P =.021），与对照组相比无差异（P =.134）。与 IV TXA（P =.029）和对照组（P =.036）相比，接受纤维蛋白密封剂治疗的患者血红蛋白水平下降更大。与对照组（P =.375）相比，接受 TISSEEL 治疗的患者术后输血率无差异，与 IV TXA 相比统计学差异更大（P =.002）。
TISSEEL 纤维蛋白粘合剂不能减少术后失血或输血；然而，与 TISSEEL 和对照组相比，IV TXA 减少了术后输血。因此，建议使用 TXA 减少围手术期失血，而纤维蛋白粘合剂的使用需要进一步改进，然后才能在 THA 中常规使用。
