Department of Orthopaedics surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Acta Orthop Traumatol Turc. 2020 Sep;54(5):519-523. doi: 10.5152/j.aott.2020.19044.
This study aimed to explore the efficacy and safety of intravenous tranexamic acid (TXA) for reducing perioperative blood loss and allogeneic blood transfusions in revision hip arthroplasty.
TXA was routinely administered as an intravenous preoperative dose in all the revision hip arthroplasty cases in our institution from December 2012. We retrospectively reviewed 803 patients who underwent revision hip arthroplasty from January 2008 to September 2018. These patients were divided into 2 groups based on whether they received intravenous TXA (n=482; 231 men and 251 women; mean age: 63.27±11.73 years) or not (n=321; 159 men and 162 women; mean age: 63.91±11.69 years). The 2 groups were compared in terms of estimated intraoperative blood loss, visible blood loss, hidden blood loss, the rate and volume of allogeneic blood transfusions, and the incidence of symptomatic venous thromboembolism. The patients were also compared depending on whether they underwent total hip revision, isolated acetabular revision, or isolated femoral revision.
Regardless of the type of revision involved, the patients who received TXA showed significantly lower estimated intraoperative blood loss, visible blood loss, hidden blood loss, and allogeneic blood transfusion rate and volume (all p values were less than 0.001). Use of TXA was not associated with significant changes in the incidence of postoperative symptomatic venous thromboembolism (p=0.911). Similar results were obtained with subgroups of patients who underwent different types of revision surgeries, except hidden blood loss (p=0.994) of patients in the isolated femoral revision subgroup.
The administration of intravenous TXA can safely and effectively reduce the perioperative blood loss and allogeneic blood transfusions in revision hip arthroplasty.
Level III, Therapeutic study.
本研究旨在探讨静脉应用氨甲环酸（TXA）减少翻修髋关节置换术围手术期失血和异体输血的效果和安全性。
自 2012 年 12 月起，我院所有翻修髋关节置换术患者常规给予术前静脉注射 TXA。我们回顾性分析了 2008 年 1 月至 2018 年 9 月期间接受翻修髋关节置换术的 803 例患者。根据是否静脉应用 TXA（n=482；男 231 例，女 251 例；平均年龄：63.27±11.73 岁）将患者分为两组，另设未应用 TXA 组（n=321；男 159 例，女 162 例；平均年龄：63.91±11.69 岁）。比较两组患者的术中估计失血量、显性失血量、隐性失血量、异体输血率和输血量以及症状性静脉血栓栓塞的发生率。并根据全髋关节翻修、单纯髋臼翻修或单纯股骨翻修比较两组患者的情况。
无论涉及何种类型的翻修，应用 TXA 的患者术中估计失血量、显性失血量、隐性失血量和异体输血率、输血量均显著降低（均 P 值<0.001）。应用 TXA 并未显著改变术后症状性静脉血栓栓塞的发生率（P=0.911）。不同类型翻修手术的亚组患者也得到了类似的结果，除单纯股骨翻修亚组患者的隐性失血量（P=0.994）外。
静脉应用 TXA 可安全、有效地减少翻修髋关节置换术围手术期失血和异体输血。
III 级，治疗性研究。
