Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Surg Oncol. 2021 Mar;123(4):1121-1125. doi: 10.1002/jso.26354. Epub 2020 Dec 23.
Advances in the care of cancer patients have resulted in increased survival. The proximal femur is a common site for metastatic disease, often requiring surgical intervention. Tranexamic acid (TXA) has proven to be safe in elective and traumatic femoral hemiarthroplasty; however, its use has not been investigated in oncologic patients.
We reviewed 66 patients (37 males) with a mean age of 64 ± 3 years undergoing a hemiarthroplasty for metastatic disease in the femoral neck. A total of 22 (33%) patients received intraoperative TXA. Primary outcomes included postoperative blood loss, intraoperative and postoperative transfusion requirement, and postoperative complications.
There was no difference in the baseline characteristics between the TXA and non-TXA groups. When comparing the TXA and non-TXA groups, there were no differences in 72 h postoperative blood loss between groups (1.21 L vs. 1.33 L, p = 0.61), percentage of patients requiring transfusion (36.4% vs. 36.4%, p = 1.0), or the incidence of postoperative complications including venous thromboembolism (14% vs. 11%, p = 0.70) and pulmonary embolism (0% vs. 5%, p = 1.0).
Oncology patients are a high-risk population for thromboembolic events. This initial study supports the safe use of TXA intraoperatively in femoral hemiarthroplasty performed for metastatic disease.
癌症患者护理的进步导致生存率提高。股骨近端是转移性疾病的常见部位，通常需要手术干预。氨甲环酸（TXA）已被证明在择期和创伤性股骨半髋关节置换术中是安全的；然而，尚未在肿瘤患者中进行研究。
我们回顾了 66 名（37 名男性）平均年龄为 64±3 岁的患者，他们因股骨颈转移性疾病接受半髋关节置换术。共有 22 名（33%）患者接受术中 TXA。主要结局包括术后出血量、术中及术后输血需求和术后并发症。
TXA 组和非-TXA 组的基线特征无差异。比较 TXA 组和非-TXA 组，两组术后 72 小时出血量无差异（1.21 L 比 1.33 L，p=0.61），需要输血的患者比例（36.4%比 36.4%，p=1.0），或术后并发症发生率，包括静脉血栓栓塞（14%比 11%，p=0.70）和肺栓塞（0%比 5%，p=1.0）。
肿瘤患者是血栓栓塞事件的高危人群。这项初步研究支持在治疗转移性疾病的股骨半髋关节置换术中术中安全使用 TXA。
