Knee Unit, Department of Orthopedic Surgery, HLA Clinica Vistahermosa, Av de Denia 76, 03016, Alicante, Spain.
Eur J Orthop Surg Traumatol. 2020 Aug;30(6):1003-1008. doi: 10.1007/s00590-020-02656-9. Epub 2020 Mar 17.
Tranexamic acid (TXA) has been shown to be effective in reducing blood loss after total knee replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use, to reduce blood loss after primary total knee replacement without tourniquet, and to compare these outcomes with a control group that did not receive tranexamic acid.
This is a prospective, randomized study to assess the effect of a 2-g topical tranexamic acid in 50 mL physiological saline solution in total knee replacement without tourniquet and drain. Primary outcomes were total blood loss. Secondary outcomes were hemoglobin and hematocrit level, hemoglobin and hematocrit drop, transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events.
Preoperative and intraoperative data were similar between the two groups. The mean total blood loss was 620 mL in the topical tranexamic acid group and 1094 mL in the control group with significant differences (p = 0.001), which meant 43% reduction in total blood loss. The hemoglobin and hematocrit postoperative value was significantly higher in the topical tranexamic acid group than in the control group (p = 0.002). Transfusion rates were 0% in the topical tranexamic group and 4.3% in the control group. The length of stay was significantly lower in the topical tranexamic acid group (p = 0.01). There were no DVT or PE in any group.
A single dose of 2-g TXA in 50 mL topical administration significantly reduces blood loss and improves postoperative blood chemistries in patients undergoing unilateral primary cemented TKA without tourniquet and drain compared to a control group, without increasing the risk of thromboembolic complications.
氨甲环酸（TXA）已被证明可有效减少全膝关节置换术后的失血。本研究旨在前瞻性评估局部使用 TXA 减少无止血带的初次全膝关节置换术后失血的有效性，并将这些结果与未使用氨甲环酸的对照组进行比较。
这是一项前瞻性、随机研究，评估了在无止血带和引流的情况下，在全膝关节置换术中使用 2g 局部 TXA 加 50ml 生理盐水对总失血量的影响。主要结局是总失血量。次要结局是血红蛋白和血细胞比容水平、血红蛋白和血细胞比容下降、输血率、住院时间、深静脉血栓形成和肺栓塞事件。
两组术前和术中数据相似。局部 TXA 组的平均总失血量为 620ml，对照组为 1094ml，差异有统计学意义（p=0.001），即总失血量减少 43%。局部 TXA 组术后血红蛋白和血细胞比容值明显高于对照组（p=0.002）。局部 TXA 组输血率为 0%，对照组为 4.3%。局部 TXA 组的住院时间明显缩短（p=0.01）。两组均无深静脉血栓形成或肺栓塞。
与对照组相比，在无止血带和引流的情况下，单次使用 2g TXA 局部 50ml 给药可显著减少单侧初次水泥固定 TKA 患者的失血量，并改善术后血液化学指标，而不会增加血栓栓塞并发症的风险。
