Department of Orthopaedics, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.
Arch Orthop Trauma Surg. 2020 Dec;140(12):2071-2075. doi: 10.1007/s00402-020-03591-4. Epub 2020 Aug 29.
Topical administration of tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) is increasingly popular as it avoids the risks related with systemic absorption of the medication. Previous studies have established the efficacy of TXA in TKA, however here are limited direct comparison studies available and the dosing regimens vary. Hence, there is no consensus on an optimal dose. Our objective is to compare blood loss, transfusion requirement and immediate post-operative function between high (2 g) and low (1 g) dose tranexamic acid in patients undergoing TKA.
This is a retrospective cohort study of 104 patients undergoing total knee arthroplasty in a single institution under a single surgeon. In total, 61 and 43 patients receiving 1 g and 2 g of topical TXA respectively. Blood loss as estimated from the difference in haemoglobin (Hb) and haematocrit (HCT) levels post-surgery and number of blood transfusions required were compared between groups. Immediate post-operative function and complications were also measured.
Patient characteristics were mostly similar between groups. The transfusion requirements were higher in 1 g group compared to the 2 g group (0.11 vs 0.00, p = 0.034). The mean post op day 1 (POD1) range of motion higher in the 1 g group vs 2 g group (72.1 vs 63.7, p = 0.035). The 2 g group had a lower POD1 pain score compared to the 1 g group (4.02 vs 5.43, p < 0.01). There was no statistically significant difference in complications that were related to the administration of TXA between the two groups.
Higher dose of topical TXA is safe, helps improve immediate post-operative functional outcomes and reduces transfusion requirements.
在全膝关节置换术（TKA）患者中，局部给予氨甲环酸（TXA）的应用越来越受欢迎，因为它避免了与药物全身吸收相关的风险。先前的研究已经证实了 TXA 在 TKA 中的疗效，然而，目前可用的直接比较研究有限，且剂量方案也存在差异。因此，目前对于最佳剂量尚无共识。我们的目的是比较高（2 克）和低（1 克）剂量 TXA 在 TKA 患者中的失血、输血需求和术后即刻功能。
这是一项单中心单外科医生的回顾性队列研究，共纳入 104 例接受 TKA 的患者。总共有 61 例和 43 例患者分别接受了 1 克和 2 克局部 TXA。比较两组之间术后血红蛋白（Hb）和血细胞比容（HCT）水平差值估计的失血和所需输血的数量。还测量了术后即刻功能和并发症。
两组患者的特征大多相似。1 克组的输血需求高于 2 克组（0.11 比 0.00，p=0.034）。1 克组术后第 1 天（POD1）的平均活动范围高于 2 克组（72.1 比 63.7，p=0.035）。与 1 克组相比，2 克组在 POD1 时的疼痛评分较低（4.02 比 5.43，p<0.01）。两组之间与 TXA 给药相关的并发症没有统计学上的显著差异。
较高剂量的局部 TXA 是安全的，有助于改善术后即刻功能结果并减少输血需求。
