Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Injury. 2020 Nov;51(11):2658-2662. doi: 10.1016/j.injury.2020.07.061. Epub 2020 Aug 1.
Intraoperative use of tranexamic acid (TXA) has been proven to reduce the administration of allogenic blood transfusion in total joint arthroplasty (TJA) patients. Data on TXA efficacy in reducing blood loss in trauma patients undergoing hip hemiarthroplasty are sparse, and its use is not yet well-established. The purpose of this study was to assess the efficacy and safety of intraoperative TXA use in patients undergoing hip hemiarthroplasty as treatment for intracapsular femoral neck fracture.
This is a historical cohort of patients who underwent hip hemiarthroplasty in a tertiary medical center between 2011 and 2019, with minimum follow-up of one year. The cohort was divided into one group of patients who received intraoperative TXA treatment and another group that did not. Blood loss, peri‑ and postoperative complications, readmissions, and short- and long-term mortality were compared between groups.
Of the 1722 consecutive patients (601 males and 1121 females) who underwent hip hemiarthroplasty who were included in this study, 504 were in the "TXA" group and 1218 were in the "non-TXA" group. TXA use significantly reduced 30-day mortality (4.6% vs 7.3%, respectively, p < 0.046) and perioperative blood loss, as indicated by changes in hemoglobin levels before and after surgery (Δ-1.38 gr/dL vs Δ-1.76 gr/dL, p < 0.001), and by administration of allogenic blood transfusions (17.5% vs 44.4%, p < 0.001).
Similar to the known effect of TXA in TJA patients, the use of TXA treatment in patients undergoing hip hemiarthroplasty led to a significant reduction in 30-day mortality, in postoperative blood loss and in the proportion of patients requiring allogenic blood transfusions.
术中使用氨甲环酸（TXA）已被证明可减少全膝关节置换术（TJA）患者异体输血的输注。关于 TXA 减少髋关节置换术患者失血的疗效的数据很少，其使用尚未得到充分确立。本研究旨在评估术中使用 TXA 治疗囊内股骨颈骨折行髋关节半髋关节置换术患者的疗效和安全性。
这是一项在 2011 年至 2019 年间在一家三级医疗中心接受髋关节半髋关节置换术的患者的历史队列研究，随访时间至少为一年。该队列分为接受术中 TXA 治疗的一组患者和未接受 TXA 治疗的一组患者。比较两组患者的失血量、围手术期并发症、再入院率以及短期和长期死亡率。
在这项研究中，共纳入了 1722 例连续接受髋关节半髋关节置换术的患者（男性 601 例，女性 1121 例），其中 504 例患者使用了 TXA（TXA 组），1218 例患者未使用 TXA（非 TXA 组）。TXA 的使用显著降低了 30 天死亡率（分别为 4.6%和 7.3%，p < 0.046）和围手术期失血，这一点可以从手术前后血红蛋白水平的变化（Δ-1.38 gr/dL 与 Δ-1.76 gr/dL，p < 0.001）和异体输血的使用情况（17.5%与 44.4%，p < 0.001）中得到证实。
与 TXA 在 TJA 患者中已知的作用相似，髋关节半髋关节置换术患者术中使用 TXA 治疗可显著降低 30 天死亡率、术后失血量以及需要异体输血的患者比例。
