静脉注射氨甲环酸一剂的效果等同于全髋关节和膝关节置换术两剂的效果。

One Dose of Intravenous Tranexamic Acid Is Equivalent to Two Doses in Total Hip and Knee Arthroplasty.

机构信息

Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California.

Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California.

出版信息

J Bone Joint Surg Am. 2018 Jul 5;100(13):1104-1109. doi: 10.2106/JBJS.17.00641.

DOI:10.2106/JBJS.17.00641

PMID:29975264

Abstract

BACKGROUND

Tranexamic acid (TXA) helps to prevent excessive blood loss during total hip arthroplasty (THA) and total knee arthroplasty (TKA), but the most efficacious dosing protocol has not been ascertained. The purpose of this study was to identify whether 1 dose of intravenous TXA is equivalent to 2 doses for reducing blood loss and transfusion rates following THA and TKA without an increase in complications.

METHODS

We identified 1,736 patients who underwent THA (592 who did not receive TXA, 454 who received 1 dose of TXA, and 690 who received 2 doses) and 2,042 patients who underwent TKA (744 who did not receive TXA, 499 who received 1 dose, and 799 who received 2 doses) from 2012 to 2016. The differences among groups with regard to the change in hemoglobin levels, rate of allogeneic blood transfusions, and rate of complications were assessed.

RESULTS

Patients who underwent THA and received 1 dose or 2 doses of TXA had similar drops in the mean hemoglobin levels postoperatively (2.9 g/dL and 3.1 g/dL, respectively; p = 0.197) and both had a smaller drop than the control group (3.6 g/dL; p < 0.001 compared with the 1 and 2-dose groups). These findings were confirmed by a multivariate analysis that controlled for age, sex, and preoperative hemoglobin level. Transfusion was required for 12.5% of the patients who underwent THA without receiving TXA, no patient who received 1 dose, and 0.7% of the patients who received 2 doses. The patients who underwent TKA and received 1 dose or 2 doses of TXA had similar mean drops in the hemoglobin level postoperatively (2.4 g/dL and 2.4 g/dL, respectively; p = 0.891), and both had less of a drop than the control group (2.9 g/dL; p < 0.001 compared with the 1 and 2-dose groups). These findings were also confirmed by a multivariate analysis that controlled for age, sex, and preoperative hemoglobin level. Transfusion was required for 4.3% of the patients who underwent TKA without receiving TXA, 0.4% of those who received 1 dose, and 0.3% of those who received 2 doses. Similar rates of perioperative complications occurred among all groups.

CONCLUSIONS

One dose of TXA was as effective as 2 doses for decreasing blood loss and transfusion rates after THA and TKA without an increase in complications.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

氨甲环酸（TXA）有助于减少全髋关节置换术（THA）和全膝关节置换术（TKA）中的失血，但最有效的给药方案尚未确定。本研究旨在确定单次静脉注射 TXA 是否与 2 次剂量一样有效，以减少 THA 和 TKA 后失血和输血率，而不会增加并发症。

方法

我们从 2012 年至 2016 年确定了 1736 名接受 THA 的患者（592 名未接受 TXA、454 名接受 1 剂 TXA、690 名接受 2 剂）和 2042 名接受 TKA 的患者（744 名未接受 TXA、499 名接受 1 剂、799 名接受 2 剂）。评估了各组血红蛋白水平变化、同种异体输血率和并发症发生率的差异。

结果

接受 THA 且接受 1 剂或 2 剂 TXA 的患者术后平均血红蛋白水平下降相似（分别为 2.9 g/dL 和 3.1 g/dL；p = 0.197），均低于对照组（3.6 g/dL；p < 0.001 与 1 剂量和 2 剂量组相比）。多变量分析控制了年龄、性别和术前血红蛋白水平，证实了这一发现。未接受 TXA 的 THA 患者中有 12.5%需要输血，接受 1 剂的患者中没有，接受 2 剂的患者中没有。接受 TKA 且接受 1 剂或 2 剂 TXA 的患者术后平均血红蛋白水平下降相似（分别为 2.4 g/dL 和 2.4 g/dL；p = 0.891），均低于对照组（2.9 g/dL；p < 0.001 与 1 剂量和 2 剂量组相比）。多变量分析控制了年龄、性别和术前血红蛋白水平，也证实了这一发现。未接受 TXA 的 TKA 患者中有 4.3%需要输血，接受 1 剂的患者中有 0.4%需要输血，接受 2 剂的患者中有 0.3%需要输血。所有组的围手术期并发症发生率相似。