Gombár Csaba, Gálity Hristifor, Bácsi Miklós, Sisák Krisztián
Szent-Györgyi Albert Klinikai Központ, Ortopédiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 6., 6725.
Ortopédiai Osztály, Bács-Kiskun Megyei Kórház Kecskemét.
Orv Hetil. 2019 Mar;160(12):456-463. doi: 10.1556/650.2019.31324.
Tranexamic acid (TXA) is widely used during elective joint replacement to reduce blood loss and decrease the transfusion requirement.
This study assessed the efficacy of tranexamic acid in reducing minor bleeding complications following primary cemented total hip replacement, when rivaroxaban is used as thromboprophylaxis, the complicated wound healing effect of which has been published recently.
Consecutive patients undergoing hip replacement were studied. Patients receiving tranexamic acid perioperatively between January 2014 and November 2014 were designated as the TXA-group. We compared these data with those of a group of patients who underwent the same procedure between February 2012 and December 2012 (control group), before the introduction of tranexamic acid. The authors investigated the effect of tranexamic acid on surgical wound bleeding and discharge, area of hematoma on the skin surface, thigh volume changes, calculated perioperative blood loss and transfusion requirement.
168 patients, 81 in the TXA-group and 87 in the control group were included. The extent of postoperative thigh swelling was significantly less in the TXA-group, 270.3 mL (129.1-449.0) as compared with the control group, 539.8 mL (350.0-864.8, p<0.001). Tranexamic acid significantly reduced wound bleeding during the first 24 hours postoperatively (p<0.001). The amount of calculated blood loss was significantly less in the TXA-group (1150 mL [780-1496] versus 1579 mL [1313-2074] in the control group, p<0.001). Transfusion requirement was remarkably lower in the TXA-group than in the control group (15% versus 39%).
Tranexamic acid reduces postoperative thigh volume, wound bleeding and area of hematoma on the skin surface when rivaroxaban is used as the anticoagulant. Further large scale studies could help establish the clinical relevance and long-term outcome of minor bleeding complications. Orv Hetil. 2019; 160(12): 456-463.
氨甲环酸（TXA）在择期关节置换术中被广泛用于减少失血并降低输血需求。
本研究评估了在使用利伐沙班进行血栓预防时，氨甲环酸在减少初次骨水泥型全髋关节置换术后轻微出血并发症方面的疗效，利伐沙班的复杂伤口愈合效应最近已有报道。
对连续接受髋关节置换术的患者进行研究。将2014年1月至2014年11月围手术期接受氨甲环酸治疗的患者指定为TXA组。我们将这些数据与一组在2012年2月至2012年12月期间（对照组）在引入氨甲环酸之前接受相同手术的患者的数据进行比较。作者研究了氨甲环酸对手术伤口出血和引流、皮肤表面血肿面积、大腿体积变化、计算的围手术期失血量和输血需求的影响。
纳入168例患者，TXA组81例，对照组87例。TXA组术后大腿肿胀程度明显较轻，为270.3 mL（129.1 - 449.0），而对照组为539.8 mL（350.0 - 864.8，p<0.001）。氨甲环酸显著减少了术后24小时内的伤口出血（p<0.001）。TXA组计算的失血量明显较少（1150 mL [780 - 1496]，而对照组为1579 mL [1313 - 2074]，p<0.001）。TXA组的输血需求明显低于对照组（15%对39%）。
当使用利伐沙班作为抗凝剂时，氨甲环酸可减少术后大腿体积、伤口出血和皮肤表面血肿面积。进一步的大规模研究有助于确定轻微出血并发症的临床相关性和长期结果。《匈牙利医学周报》。2019年；160(12):456 - 463。
