Zhongshan Hospital, Xiamen University, Fujian 361004, China.
Zhongshan Hospital, Xiamen University, Fujian 361004, China.
Thromb Res. 2020 Apr;188:39-43. doi: 10.1016/j.thromres.2020.02.001. Epub 2020 Feb 4.
Total knee arthroplasty (TKA) has been considered as an effective choice for end-stage osteoarthritis or rheumatic arthritis. Tranexamic acid (TXA) has been widely used to prevent excessive blood loss perioperatively. Similarly, hemocoagulase atrox can significantly diminish blood loss and transfusion requirements in surgeries, however, it was rarely used in TKA. The purpose of this study is to identify whether hemocoagulase atrox is equal to TXA in reducing blood loss and transfusion rates following TKA, and compare clinical outcomes and complications between the two groups.
74 patients were randomized to receive TXA (1.5 g intra-articular combined with 1.5 g intravenous), or hemocoagulase atrox (1 U intra-articular combined with 1 U intravenous). The primary outcome was total blood loss. The secondary outcomes included reduction of hemoglobin concentration, clinical outcomes, blood coagulation values, thromboembolic complications, and transfusion rates.
The mean total blood loss was 431.7 mL in the TXA group compared with 644.6 mL in the hemocoagulase atrox group, with statistical significance (P < 0.05). There were significant differences in reduction of hemoglobin level (P < 0.05). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given hemocoagulase atrox, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay and clinical outcomes.
Although the blood loss was significantly greater in the hemocoagulase atrox group, no transfusions were required and no significant differences were observed for any other outcomes measured. Meanwhile, the rate of DVT in the hemocoagulase atrox group tends to be lower than those in TXA group. We concluded that hemocoagulase atrox was not superior to TXA in reducing perioperative blood loss. Further studies are warranted to evaluate if hemocoagulase atrox use could improve perioperative blood loss in patients with high thrombotic risk undergoing TKA.
全膝关节置换术（TKA）已被认为是治疗终末期骨关节炎或类风湿关节炎的有效方法。氨甲环酸（TXA）已广泛用于预防围手术期的过度失血。同样，巴曲亭也可以显著减少手术中的失血量和输血需求，但在 TKA 中很少使用。本研究旨在确定巴曲亭在减少 TKA 术后出血量和输血率方面是否与 TXA 相当，并比较两组的临床结果和并发症。
74 例患者随机分为 TXA（关节内 1.5 g 联合静脉内 1.5 g）组或巴曲亭（关节内 1 U 联合静脉内 1 U）组。主要结局是总失血量。次要结局包括血红蛋白浓度降低、临床结果、凝血值、血栓栓塞并发症和输血率。
TXA 组平均总失血量为 431.7 mL，巴曲亭组为 644.6 mL，差异有统计学意义（P<0.05）。血红蛋白水平降低有显著差异（P<0.05）。给予 TXA 的患者深静脉血栓形成（DVT）的发生率高于给予巴曲亭的患者，但差异无统计学意义。两组均无需输血，且住院时间和临床结果无显著差异。
尽管巴曲亭组的失血量明显较多，但无需输血，且其他测量结果无显著差异。同时，巴曲亭组的 DVT 发生率低于 TXA 组。我们得出结论，巴曲亭在减少围手术期失血方面并不优于 TXA。需要进一步的研究来评估巴曲亭在高血栓风险的 TKA 患者中是否能改善围手术期失血。
