Lum Zachary C, Manoukian Martin A C, Pacheco Christopher S, Nedopil Alexander J, Giordani Mauro, Meehan John P
Department of Orthopaedics, Adult Reconstruction Section, University of California: Davis Medical Center, Sacramento, CA.
J Am Acad Orthop Surg Glob Res Rev. 2018 Nov 7;2(11):e072. doi: 10.5435/JAAOSGlobal-D-18-00072. eCollection 2018 Nov.
Since the advent of antifibrinolytics, blood transfusions and their associated complications in total joint arthroplasty have decreased. Few studies have compared different antifibrinolytic types with respect to blood loss and transfusion rates. We sought to compare the blood loss and transfusion rates between epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), and control.
A total of 564 patients underwent primary total hip or total knee arthroplasty at our institution. Patients were divided into 3 groups: 183 EACA, 204 TXA, and 177 control. Patient demographics, hemoglobin, transfusion rates, and blood loss were collected.
Patient preoperative variables were similar. The control group had a mean estimated blood loss (EBL) of 1.48 L, with 51 units of packed red blood cells (pRBCs) given and 14.7% of patients receiving a blood transfusion. The EACA group had an EBL of 1.33 L, with 20 pRBCs given and 10.9% of patients receiving a transfusion. The TXA group had an EBL of 1.05 L, with 3 pRBCs transfused in 0.98% of patients. Compared with the control group, blood loss ( = 0.0014; < 0.0001), number of pRBCs given ( = 0.007; < 0.0001), and number of patients transfused ( = 0.012; < 0.0001) were significantly lower in the EACA and TXA groups, respectively. TXA had significantly lower blood loss ( < 0.0001), lower number of tranfusions ( = 0.005), and less patients transfused ( = 0.003) compared with EACA.
Our study reports lower blood loss, transfusion rates, and number of patients needing transfusion with both EACA and TXA in the setting of total joint arthroplasty. When comparing between EACA and TXA, TXA had lower blood loss, transfusion rates, and number of patients requiring transfusion.
自从抗纤维蛋白溶解药物问世以来，全关节置换术中的输血及其相关并发症有所减少。很少有研究就失血情况和输血率对不同类型的抗纤维蛋白溶解药物进行比较。我们试图比较ε-氨基己酸（EACA）、氨甲环酸（TXA）与对照组之间的失血情况和输血率。
共有564例患者在我们机构接受初次全髋关节或全膝关节置换术。患者被分为3组：183例使用EACA，204例使用TXA，177例为对照组。收集患者的人口统计学资料、血红蛋白、输血率和失血量。
患者术前变量相似。对照组的平均估计失血量（EBL）为1.48升，输注了51单位的浓缩红细胞（pRBC），14.7%的患者接受了输血。EACA组的EBL为1.33升，输注了20单位pRBC，10.9%的患者接受了输血。TXA组的EBL为1.05升，0.98%的患者输注了3单位pRBC。与对照组相比，EACA组和TXA组的失血量（P = 0.0014；P < 0.0001）、输注的pRBC数量（P = 0.007；P < 0.0001）和接受输血的患者数量（P = 0.012；P < 0.0001）分别显著更低。与EACA相比，TXA的失血量显著更低（P < 0.0001）、输血次数更少（P = 0.005）且接受输血的患者更少（P = 0.003）。
我们的研究报告了在全关节置换术中，EACA和TXA均有更低的失血量、输血率以及需要输血的患者数量。在比较EACA和TXA时，TXA的失血量、输血率以及需要输血的患者数量更低。
