Aga Khan University Medical College, Pakistan.
Aga Khan University Medical College, Pakistan.
Int J Surg. 2018 Apr;52:25-29. doi: 10.1016/j.ijsu.2018.02.005. Epub 2018 Feb 10.
Together with evidence of higher bleeding tendencies, the vulnerability of the South-Asian population to anemia secondary to a higher prevalence of hemoglobinopathies and micronutrient deficiencies merits further exploration of the effects of tranexamic acid on this population. Additionally, limited access to self-care facilities and certain sociocultural beliefs and practices may not be conducive to a speedy recovery from surgical complications. The aim of this study is to investigate the effects of intraoperative administration of tranexamic acid during total knee arthroplasty when considering the South-Asian population.
Medical record files of 355 patients who underwent total knee arthroplasty (2007-2015) were reviewed to collect data regarding patient characteristics, surgical variables and post-operative complications. Unilateral and Bilateral total knee arthroplasty were studied separately. Analysis was done using t-test, Mann-Whitney U test, chi-square and Fisher's exact square where appropriate. The threshold for significance was p < 0.05.
The study showed that for unilateral surgery, tranexamic acid caused a significant reduction in estimated blood loss (p-value=0.011), total operative time, calculated blood loss, and hemoglobin change (p-value<0.001) whereas in bilateral surgery, tranexamic acid only caused a significant reduction in calculated blood loss (p-value < 0.001) and hemoglobin change (p-value=0.001). Interestingly, in those who received tranexamic acid vs. those who did not, there was a significant increase in length of hospital stay (p<0.001) and special care unit admissions (p-value=0.033) in unilateral and bilateral surgery respectively.
Although tranexamic acid effectively reduces intraoperative blood loss, it does not have an effect on the need for post-operative blood transfusions. The increased length of stay and special care unit admissions associated with tranexamic acid use should be explored further to reveal the complete safety profile of tranexamic acid administration in the South-Asian population during total knee arthroplasty.
南亚人群由于血红蛋白病和微量营养素缺乏症的患病率较高，出血倾向较高，因此有必要进一步探讨氨甲环酸对该人群的影响。此外，获得自我护理设施的机会有限以及某些社会文化信仰和实践可能不利于从手术并发症中快速康复。本研究旨在研究在考虑南亚人群的情况下，全膝关节置换术中术中给予氨甲环酸对全膝关节置换术的影响。
回顾了 355 名接受全膝关节置换术（2007-2015 年）的患者的病历档案，以收集有关患者特征，手术变量和术后并发症的数据。分别对单侧和双侧全膝关节置换术进行了研究。使用 t 检验，Mann-Whitney U 检验，卡方检验和Fisher's 确切概率法进行分析，适当情况下使用。显著性阈值为 p<0.05。
研究表明，对于单侧手术，氨甲环酸可显著减少估计失血量（p 值=0.011），总手术时间，计算失血量和血红蛋白变化（p 值<0.001），而在双侧手术中，氨甲环酸仅导致计算失血量（p 值<0.001）和血红蛋白变化（p 值=0.001）显著减少。有趣的是，在接受氨甲环酸的患者与未接受氨甲环酸的患者相比，单侧和双侧手术的住院时间（p<0.001）和特殊护理病房入院率（p 值=0.033）均显着增加。
尽管氨甲环酸可有效减少术中失血量，但对术后输血的需求没有影响。氨甲环酸使用相关的住院时间和特殊护理病房入院率的增加应进一步探讨，以揭示氨甲环酸在南亚人群全膝关节置换术中的完整安全性概况。
