Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Department For Planned Orthopedic Surgery, Naestved Hospital, Naestved, Denmark.
J Bone Joint Surg Am. 2018 Oct 17;100(20):1742-1749. doi: 10.2106/JBJS.17.01518.
There have been concerns that the antifibrinolytic drug tranexamic acid (TXA) might increase the postoperative risk of cardiovascular events. Our objective was to determine whether perioperative TXA use is associated with cardiovascular events and death within 30 days after primary total hip arthroplasty (THA).
We conducted a nationwide cohort study of cardiovascular outcomes after perioperative exposure to tranexamic acid during THA. We included 45,290 patients who had a THA in the study period of 2006 to 2013; 38,586 received perioperative TXA, and 6,704 did not. Propensity scores were calculated on the basis of age, sex, income, year of surgery, Elixhauser comorbidity index, and a variety of comorbidities and coprescribed medications. The primary outcome was venous thromboembolism. The secondary outcomes were deep venous thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and all-cause mortality. Data were analyzed using Cox regression, either in a multivariable model with inclusion of covariates (full cohorts) or in propensity-score-matched cohorts.
After propensity score matching, all prognostic covariates balanced well. In the matched cohort, TXA use was not found to significantly increase the risk of venous thromboembolism (hazard ratio [HR] = 1.18; 95% confidence interval [CI] = 0.83 to 1.68), deep vein thrombosis (HR = 1.15; CI = 0.78 to 1.68), pulmonary embolism (HR = 1.50; CI = 0.60 to 3.78), myocardial infarction (HR = 0.83; CI = 0.46 to 1.50), ischemic stroke (HR = 0.89; CI = 0.39 to 2.01), or all-cause mortality (HR = 0.73; CI = 0.41 to 1.28). Similar results were found in the multivariable Cox regression analyses.
Our data do not support a detrimental effect of TXA on the risk of cardiovascular events or death following THA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
人们一直担心抗纤维蛋白溶解药物氨甲环酸（TXA）可能会增加髋关节置换术后心血管事件的风险。我们的目的是确定围手术期使用氨甲环酸是否与初次全髋关节置换术（THA）后 30 天内的心血管事件和死亡有关。
我们进行了一项全国性队列研究，以评估围手术期使用氨甲环酸与 THA 后心血管结局之间的关系。我们纳入了在 2006 年至 2013 年期间接受 THA 的 45290 名患者；其中 38586 名患者接受了围手术期氨甲环酸治疗，6704 名患者未接受。基于年龄、性别、收入、手术年份、Elixhauser 合并症指数以及各种合并症和合并用药情况，计算了倾向评分。主要结局是静脉血栓栓塞症。次要结局是深静脉血栓形成、肺栓塞、心肌梗死、缺血性卒中和全因死亡率。使用 Cox 回归分析数据，包括纳入协变量的多变量模型（全队列）或倾向评分匹配队列。
在进行倾向评分匹配后，所有预后协变量均得到很好的平衡。在匹配队列中，氨甲环酸的使用并未显著增加静脉血栓栓塞症（风险比[HR] = 1.18；95%置信区间[CI] = 0.83 至 1.68）、深静脉血栓形成（HR = 1.15；CI = 0.78 至 1.68）、肺栓塞（HR = 1.50；CI = 0.60 至 3.78）、心肌梗死（HR = 0.83；CI = 0.46 至 1.50）、缺血性卒中和全因死亡率（HR = 0.73；CI = 0.41 至 1.28）的风险。多变量 Cox 回归分析也得到了相似的结果。
我们的数据不支持氨甲环酸对 THA 后心血管事件或死亡风险有不良影响。
治疗性 III 级。有关证据水平的完整说明，请参见作者指南。
