From the Section for Plastic and Reconstructive Surgery, Clinic of Surgery, the Clinic of Anesthesia and Intensive Care, and the Department of Clinical Pharmacology, St. Olav's University Hospital; the Departments of Circulation and Medical Imaging and Clinical and Molecular Medicine, Norwegian University of Science and Technology; and the Section for Plastic Surgery, Aleris Medical Center.
Plast Reconstr Surg. 2019 Jun;143(6):1169e-1178e. doi: 10.1097/PRS.0000000000005620.
Topical administration of tranexamic acid to reduce bleeding is receiving increasing attention, as it is inexpensive, simple, and possibly beneficial in most surgery. Concerns regarding potential systemic adverse effects such as thromboembolic events and seizures may prevent general use of tranexamic acid. Although serum concentrations after topical application are assumed to be low, proper pharmacokinetic studies of tranexamic acid after topical application are lacking.
The authors have investigated systemic absorption of tranexamic acid after two means of topical administration in patients undergoing abdominoplasty after massive weight loss: a bolus of 200 ml of 5 mg/ml into the wound cavity versus moistening the wound surface with 20 ml of 25 mg/ml. Twelve patients were recruited in each group. Serum concentrations achieved were compared with those after administration of 1 g as an intravenous bolus to arthroplasty patients. Serial blood samples for tranexamic acid analysis were obtained for up to 24 hours.
After intravenous administration, the peak serum concentration was 66.1 ± 13.0 µg/ml after 6 ± 2 minutes. Peak serum concentration after topical moistening was 5.2 ± 2.6 µg/ml after 80 ± 33 minutes, and in the topical bolus group, it was 4.9 ± 1.8 µg/ml after 359 ± 70 minutes. Topical moistening resulted in homogenous and predictable absorption across the individuals included, whereas topical bolus administration caused variable and unpredictable serum concentrations.
Topical administration of tranexamic acid in patients undergoing abdominoplasty results in low serum concentrations, which are highly unlikely to cause systemic effects.
局部应用氨甲环酸以减少出血的方法越来越受到关注，因为它价格低廉、操作简单，并且在大多数手术中可能有益。由于担心潜在的全身性不良影响，如血栓栓塞事件和癫痫发作，氨甲环酸的常规使用可能受到限制。尽管局部应用后血清浓度较低，但缺乏关于局部应用氨甲环酸后的适当药代动力学研究。
作者研究了两种局部应用方法后，在接受巨量体重减轻后行腹部整形术的患者中氨甲环酸的全身吸收情况：将 200 毫升 5 毫克/毫升的溶液一次性注入伤口腔，或用 20 毫升 25 毫克/毫升的溶液湿润伤口表面。每组招募了 12 名患者。将达到的血清浓度与关节置换术患者静脉注射 1 克氨甲环酸后的浓度进行比较。在长达 24 小时的时间内，采集了用于分析氨甲环酸的连续血样。
静脉注射后，6±2 分钟时血清峰浓度为 66.1±13.0µg/ml。局部湿润组的血清峰浓度为 80±33 分钟时为 5.2±2.6µg/ml，局部注射组为 359±70 分钟时为 4.9±1.8µg/ml。局部湿润导致个体之间的吸收均匀且可预测，而局部注射则导致血清浓度变化且不可预测。
在接受腹部整形术的患者中局部应用氨甲环酸可导致低血清浓度，极不可能引起全身性作用。
