Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Oxford Surgical Collaborative for Audit and Research, Oxford, UK.
Anaesthesia. 2020 Aug;75(8):1050-1058. doi: 10.1111/anae.15056. Epub 2020 Jun 4.
In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration. Patients undergoing primary total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty during a 2-week period were eligible for inclusion in this prospective study. The primary outcome was the proportion of patients receiving tranexamic acid in the peri-operative period. Secondary outcomes included: dose, route and timing of tranexamic acid administration; prevalence of pre- and postoperative anaemia; estimated blood loss; and red blood cell transfusion rates. In total, we recruited 1701 patients from 56 NHS hospitals. Out of these, 1523 (89.5%) patients received tranexamic acid and of those, 1052 (69.1%) received a single dose of 1000 mg intravenously either pre- or intra-operatively. Out of the 1701 patients, 571 (33.6%) and 1386 (81.5%) patients were anaemic (haemoglobin < 130 g.l ) in the pre- and postoperative period, respectively. Mean (SD) estimated blood loss for all included patients was 792 (453) ml and 54 patients (3.1%) received a red blood cell transfusion postoperatively. The transfusion rate for patients with pre-operative anaemia was 6.5%, compared with 1.5% in patients without anaemia. Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.
在英国，对于预计失血量超过 500 毫升的所有手术，都推荐使用氨甲环酸。然而，其最佳剂量、给药途径和时机尚不清楚。本研究旨在评估围手术期氨甲环酸给药的现状。在为期 2 周的时间内，接受初次全髋关节置换术、全膝关节置换术或单髁膝关节置换术的患者符合本前瞻性研究的纳入标准。主要结局是接受围手术期氨甲环酸治疗的患者比例。次要结局包括：氨甲环酸的剂量、给药途径和时机；术前和术后贫血的发生率；估计失血量；以及红细胞输血率。共从 56 家 NHS 医院招募了 1701 名患者。其中，1523 名（89.5%）患者接受了氨甲环酸治疗，其中 1052 名（69.1%）患者接受了术前或术中单次静脉滴注 1000mg 氨甲环酸。在 1701 名患者中，分别有 571 名（33.6%）和 1386 名（81.5%）患者在术前和术后出现贫血（血红蛋白<130g.l）。所有纳入患者的平均（SD）估计失血量为 792（453）ml，54 名（3.1%）患者术后接受了红细胞输血。术前贫血患者的输血率为 6.5%，无贫血患者的输血率为 1.5%。英国目前的标准治疗方案是在术前或术中静脉滴注 1000mg 氨甲环酸。大约三分之一的患者在接受手术时存在贫血，尽管总的红细胞输血率较低。这些数据为评估氨甲环酸和其他患者血液管理干预措施在未来研究中的疗效提供了有用的对照。
