Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Bone Joint J. 2019 Jun;101-B(6_Supple_B):104-109. doi: 10.1302/0301-620X.101B6.BJJ-2018-1376.R1.
Tranexamic acid (TXA) has been shown to significantly reduce transfusion rates in primary total hip arthroplasties (THAs), but high-quality evidence is limited in the revision setting. The purpose of the current study was to compare the rate of blood transfusions and symptomatic venous thromboembolic events (VTEs) in a large cohort of revision THAs treated with or without intravenous (IV) TXA.
We performed a retrospective review of 3264 revision THAs (2645 patients) between 2005 and 2014, of which 1142 procedures received IV TXA (1 g at incision and 1 g at closure). The mean age in the revision group with TXA was 65 years (28 to 95), with 579 female patients (51%). The mean age in the revision group treated without TXA was 67 years (21 to 98), with 1160 female patients (55%). Outcomes analyzed included rates of transfusion and symptomatic VTEs between procedures undertaken with and without TXA. These comparisons were performed for the overall cohort, as well as within cases subcategorized for aseptic or septic aetiologies. A propensity score was developed to minimize bias between groups and utilized age at revision THA, sex, body mass index, American Society of Anesthesiologists (ASA) score, preoperative anticoagulation, and year of surgery.
Tranexamic acid significantly and substantially reduced the rate of blood transfusions after revision THA overall from 54% to 26% (p < 0.001; adjusted relative risk (RR) 1.6; 95% confidence interval (CI) 1.3 to 1.9), with a significant reduction in both aseptic (49% to 18%; p < 0.001) and septic (73% to 53%; p = 0.04) revisions. The rate of VTE was minimal overall, with three events (0.3%) in the TXA group and four events (0.2%) in the non-TXA group. There were no significant differences in VTE rates based on TXA use or aetiology of revision.
Intravenous TXA significantly reduced transfusion rates during all-cause revision THAs, including a subgroup analysis of both aseptic and septic cohorts. Adjusted risk using propensity modelling showed no statistical difference in rates of VTEs between either group. Cite this article: 2019;100-B(6 Supple B):104-109.
氨甲环酸（TXA）已被证明可显著降低初次全髋关节置换术（THA）中的输血率，但在翻修手术中，高质量的证据有限。本研究的目的是比较大样本量的翻修 THA 患者中使用和不使用静脉（IV）TXA 治疗时的输血率和症状性静脉血栓栓塞事件（VTE）发生率。
我们回顾性分析了 2005 年至 2014 年间 3264 例（2645 例患者）翻修 THA，其中 1142 例接受了 IV TXA（切开时 1g，关闭时 1g）。TXA 治疗组的平均年龄为 65 岁（28 至 95 岁），其中 579 例为女性（51%）。未使用 TXA 治疗组的平均年龄为 67 岁（21 至 98 岁），其中 1160 例为女性（55%）。分析的结果包括使用和不使用 TXA 治疗的手术之间的输血率和症状性 VTE 发生率。这些比较是针对总体队列进行的，以及根据无菌或感染性病因进行的病例亚分类。为了尽量减少组间的偏倚，我们制定了一个倾向评分，并使用了翻修 THA 时的年龄、性别、体重指数、美国麻醉医师协会（ASA）评分、术前抗凝和手术年份。
TXA 显著降低了翻修 THA 后输血率，总体从 54%降至 26%（p<0.001；调整后的相对风险（RR）1.6；95%置信区间（CI）1.3 至 1.9），无菌（49%降至 18%；p<0.001）和感染性（73%降至 53%；p=0.04）翻修手术中均有显著降低。VTE 的发生率总体较低，TXA 组有 3 例（0.3%），非 TXA 组有 4 例（0.2%）。VTE 发生率与 TXA 使用或翻修病因无关，无统计学差异。
静脉内 TXA 显著降低了所有原因的翻修 THA 的输血率，包括对无菌和感染性队列的亚组分析。使用倾向评分调整风险后，两组之间的 VTE 发生率无统计学差异。
2019;100-B(6 Supple B):104-109.
