Meftah Morteza, White Peter B, Siddiqi Ahmed, Siddappa Vinay H, Kirschenbaum Ira
BronxCare Hospital Center, Bronx, New York.
Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.
Surg Technol Int. 2019 May 15;34:451-455.
While tranexamic acid (TXA) has been well shown to reduce blood loss after joint replacement surgery, little is known regarding its effectiveness in obese patients. The aim of this study was to evaluate the effect of TXA changes in hematocrit and hemoglobin levels as well as incidence of packed red blood cell (pRBC) transfusions in obese patients undergoing total joint arthroplasty (TJA).
Between January 2014 and May 2015, 420 consecutive primary joint replacements were performed by two surgeons at our institution. One-hundred-fifty-seven patients (total hip arthroplasty [THA]=29; total knee arthroplasty [TKA]=128) were obese with a body mass index (BMI) greater than or equal to 30 kg/m2. Medical records were reviewed and identified that TXA was utilized in 85 (54.1%) arthroplasties (study group) and was compared to a consecutive series of 72 (45.9%) TJAs (control group). TXA was given intravenously (IV) in two doses: (1) one gram prior to incision and (2) one gram at the time of femoral preparation in THA or prior to cementation in TKA. Changes in hemoglobin and hematocrit levels, number of pRBC transfusions, and occurrence of thrombolytic events were recorded.
The changes in hematocrit (7.2% vs. 8.1%) and hemoglobin levels (3.0 g/dl vs. 3.3 g/dl) were less in the group that received TXA than the control group, albeit not significantly (p=0.100 and p=0.278, respectively). Within the control group, 26 (36.1%) patients required a pRBC transfusion with a mean of 2.0 units per patient (range:1-5); whereas, only eight (9.4%) patients with TXA required a mean of 1.6 units per patient (range: 1-2). The use of TXA significantly reduced the incidence of pRBC transfusions, especially in TKA (p<0.001). Sub-analyses revealed that transfusion rates were even more significantly reduced by TXA in obesity type II and III. Two pulmonary emboli were reported in the group that did not receive TXA; whereas, no thrombolytic events were reported in the group that did receive TXA.
Utilization of TXA significantly reduced the rate of pRBC transfusions in obese patients.
尽管氨甲环酸（TXA）已被充分证明可减少关节置换术后的失血，但对于其在肥胖患者中的有效性知之甚少。本研究的目的是评估TXA对接受全关节置换术（TJA）的肥胖患者血细胞比容和血红蛋白水平变化以及浓缩红细胞（pRBC）输血发生率的影响。
2014年1月至2015年5月期间，我们机构的两位外科医生连续进行了420例初次关节置换手术。157例患者（全髋关节置换术[THA]=29例；全膝关节置换术[TKA]=128例）为肥胖患者，体重指数（BMI）大于或等于30kg/m²。回顾病历发现，85例（54.1%）关节置换手术（研究组）使用了TXA，并与连续的72例（45.9%）TJA（对照组）进行比较。TXA分两次静脉注射（IV）：（1）切口前1克；（2）THA股骨准备时或TKA骨水泥固定前1克。记录血红蛋白和血细胞比容水平的变化、pRBC输血次数以及溶栓事件的发生情况。
接受TXA的组血细胞比容（7.2%对8.1%）和血红蛋白水平（3.0g/dl对3.3g/dl）的变化低于对照组，尽管差异不显著（分别为p=0.100和p=0.278）。在对照组中，26例（36.1%）患者需要pRBC输血，平均每位患者2.0单位（范围：1 - 5）；而使用TXA的患者中，只有8例（9.4%）需要输血，平均每位患者1.6单位（范围：1 - 2）。使用TXA显著降低了pRBC输血的发生率，尤其是在TKA中（p<0.001）。亚组分析显示，TXA在II型和III型肥胖患者中更显著地降低了输血率。未接受TXA的组报告了2例肺栓塞；而接受TXA的组未报告溶栓事件。
使用TXA显著降低了肥胖患者的pRBC输血率。
