Stoicea Nicoleta, Moran Kenneth, Mahmoud Abdel-Rasoul, Glassman Andrew, Ellis Thomas, Ryan John, Granger Jeffrey, Joseph Nicholas, Salon Nathan, Ackermann Wiebke, Rogers Barbara, Niermeyer Weston, Bergese Sergio D
Department of Anesthesiology Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus Orthopedic One, Dublin Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL College of Medicine, The Ohio State University Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Medicine (Baltimore). 2018 May;97(21):e10720. doi: 10.1097/MD.0000000000010720.
Tranexamic acid (TXA) is an antifibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported side effects of high-dose TXA administration, including myocardial infarction (MI), thromboembolic events, and seizures. These possible side effects have prevented the widespread adoption of TXA in the surgical community.
We conducted a retrospective chart review of 564 primary and revision THAs performed at a single academic center. Surgical patients received either no TXA or 1 g IV TXA at the beginning of surgery followed by a second bolus just before the surgical wound closure, at the surgeon's discretion. We analyzed differences in hemoglobin (Hb), hematocrit (Hct), estimated blood loss (EBL), and adverse events in patients receiving TXA versus patients not receiving TXA up to 2 days following surgery.
Significantly higher Hb and Hct values were found across all time points among patients undergoing primary posterior or revision THA who had received TXA. In addition, transfusion rates were significantly decreased in both primary posterior THAs and revision THAs when TXA was administered. Patients who received TXA experienced significantly fewer adverse events than those who did not for all surgery types.
Administration of low-dose intravenous (IV) and intra-articular (IA) TXA does not appear to increase rates of adverse events and may be effective in minimizing blood loss, as reflected by Hb and Hct values following THA.
氨甲环酸（TXA）是一种抗纤溶药物，已显示出在全髋关节置换术（THA）中减少失血的前景。多项研究报告了高剂量使用TXA的副作用，包括心肌梗死（MI）、血栓栓塞事件和癫痫发作。这些可能的副作用阻碍了TXA在外科领域的广泛应用。
我们对在一个学术中心进行的564例初次和翻修THA手术进行了回顾性图表审查。手术患者在手术开始时要么不使用TXA，要么静脉注射1g TXA，然后在手术伤口闭合前由外科医生酌情给予第二次推注。我们分析了接受TXA与未接受TXA的患者在术后2天内血红蛋白（Hb）、血细胞比容（Hct）、估计失血量（EBL）和不良事件的差异。
在接受TXA的初次后路或翻修THA患者的所有时间点上，Hb和Hct值均显著更高。此外，在初次后路THA和翻修THA中，使用TXA时输血率均显著降低。接受TXA的患者在所有手术类型中经历的不良事件明显少于未接受TXA的患者。
低剂量静脉注射（IV）和关节内注射（IA）TXA似乎不会增加不良事件发生率，并且可能有效地减少失血，如THA后Hb和Hct值所反映的那样。
