序贯静脉和口服氨甲环酸对全膝关节置换术后血红蛋白下降的影响：一项随机对照试验。

Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty: A Randomized Controlled Trial.

机构信息

Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.

Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, South Korea.

出版信息

J Bone Joint Surg Am. 2022 Jan 19;104(2):154-159. doi: 10.2106/JBJS.20.02174.

DOI:10.2106/JBJS.20.02174

PMID:34705756

Abstract

BACKGROUND

Tranexamic acid (TXA) is typically discontinued on the day of total knee arthroplasty (TKA). However, bleeding may persist for several days. We sought to determine whether sequential administration of intravenous (IV) and oral TXA could reduce hemoglobin (Hb) drop more than IV TXA alone. We also wanted to determine whether the use of additional oral TXA increased the rate of complications of deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE).

METHODS

This prospective, randomized controlled trial included 141 patients. We compared the Hb drop, estimated blood loss (EBL), and transfusion rate of patients receiving IV TXA alone (group IV, n = 48) to those of patients who received IV TXA followed by oral TXA for 2 days (group 2D, n = 46) or 5 days (group 5D, n = 47). IV TXA was administered 10 minutes prior to the tourniquet release and 3 hours after the first IV TXA administration. Computed tomography (CT) was performed on postoperative day 6 to identify radiographic evidence of DVT. We also assessed the prevalence of symptomatic DVT and PE.

RESULTS

There were no differences in maximal Hb drop, Hb drops measured at each time point, EBL, or transfusion rate among the 3 groups. The mean maximal Hb drop was 3.5 g/dL in group IV, 3.2 g/dL in group 2D, and 3.4 g/dL in group 5D. The mean EBL was 999.9 mL in group IV, 886.4 mL in group 2D, and 972.5 mL in group 5D. One patient in each group required a transfusion. There were no differences in the prevalence of radiographic evidence of DVT or symptomatic DVT. Symptomatic DVT occurred in 3 patients in group IV and 2 patients in group 5D. One patient in group IV developed a symptomatic PE.

CONCLUSIONS

Although there was no increase in the complication rate, the sequential administration of oral TXA for up to 5 days after IV TXA did not decrease Hb drop. Therefore, our findings suggest that sequential use of oral and IV TXA is not recommended.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

氨甲环酸（TXA）通常在全膝关节置换术（TKA）当天停止使用。然而，出血可能会持续数天。我们试图确定静脉（IV）和口服 TXA 的序贯给药是否比单独使用 IV TXA 更能减少血红蛋白（Hb）下降。我们还想确定是否使用额外的口服 TXA 会增加深静脉血栓形成（DVT）或有症状肺栓塞（PE）的并发症发生率。

方法

这项前瞻性、随机对照试验纳入了 141 名患者。我们比较了单独接受 IV TXA 治疗的患者（IV 组，n = 48）与接受 IV TXA 后再接受 2 天（2D 组，n = 46）或 5 天（5D 组，n = 47）口服 TXA 治疗的患者的 Hb 下降、估计失血量（EBL）和输血率。IV TXA 在止血带释放前 10 分钟和首次 IV TXA 给药后 3 小时给予。术后第 6 天行计算机断层扫描（CT）以确定影像学证据 DVT。我们还评估了有症状 DVT 和 PE 的发生率。

结果

三组之间最大 Hb 下降、各时间点 Hb 下降、EBL 和输血率均无差异。IV 组最大 Hb 下降均值为 3.5 g/dL，2D 组为 3.2 g/dL，5D 组为 3.4 g/dL。IV 组平均 EBL 为 999.9 mL，2D 组为 886.4 mL，5D 组为 972.5 mL。三组各有 1 例患者需要输血。三组之间影像学证据 DVT 或有症状 DVT 的发生率无差异。IV 组有 3 例患者发生有症状 DVT，5D 组有 2 例患者发生有症状 DVT。IV 组有 1 例患者发生有症状 PE。