Carr Bryan, Li Shi-Wen, Hill Jamel G, Feizpour Cyrus, Zarzaur Ben L, Savage Stephanie
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Trauma Surg Acute Care Open. 2023 Mar 10;8(1):e001054. doi: 10.1136/tsaco-2022-001054. eCollection 2023.
Orthopedic literature has demonstrated a significant decrease in postoperative transfusion requirements when tranexamic acid (TXA) was given during elective joint arthroplasty. The purpose of this study was to evaluate the empiric use of TXA in semi-urgent orthopedic procedures following injury. We hypothesized that TXA would be associated with increased rates of venous thromboembolic events (VTE) and have no effect on transfusion requirements.
Patients who empirically received TXA during a semi-urgent orthopedic surgery following injury (TXA+) were matched using propensity scoring to historical controls (CONTROL) who did not receive TXA. Outcomes included VTE within 6 months of injury and packed red blood cell utilization. Multivariable logistic regression and generalized linear modeling were used to determine odds of VTE and transfusion.
200 patients were included in each group. There was no difference in mortality between groups. TXA+ patients did not have an increase in VTE events (OR 0.680, 95% CI 0.206 to 2.248). TXA+ patients had a significantly higher odds of being transfused during their hospital stay (OR 2.175, 95% CI 1.246 to 3.797) and during the index surgery (increased 0.95 units (SD 0.16), p<0.0001). Overall transfusion was also significantly higher in the TXA+ group (p=0.0021).
Empiric use of TXA in semi-urgent orthopedic surgeries did not increase the odds of VTE. Despite the elective literature, TXA administration did not associate with less transfusion requirements. A properly powered, prospective, randomized trial should be designed to elucidate the risks and benefits associated with TXA use in this setting.
Level IV.
骨科文献表明，在择期关节置换术中使用氨甲环酸（TXA）时，术后输血需求量显著降低。本研究的目的是评估TXA在创伤后半急诊骨科手术中的经验性使用情况。我们假设TXA会增加静脉血栓栓塞事件（VTE）的发生率，且对输血需求无影响。
在创伤后半急诊骨科手术中经验性接受TXA治疗的患者（TXA+组），采用倾向评分法与未接受TXA治疗的历史对照组（对照组）进行匹配。观察指标包括受伤后6个月内的VTE以及红细胞悬液的使用情况。采用多变量逻辑回归和广义线性模型来确定VTE和输血的几率。
每组纳入200例患者。两组间死亡率无差异。TXA+组患者的VTE事件未增加（比值比0.680，95%置信区间0.206至2.248）。TXA+组患者在住院期间（比值比2.175，95%置信区间1.246至3.797）和初次手术期间（增加0.95单位（标准差0.16），p<0.0001）接受输血的几率显著更高。TXA+组的总体输血量也显著更高（p=0.0021）。
在半急诊骨科手术中经验性使用TXA并未增加VTE的几率。尽管有择期手术的相关文献，但TXA的使用并未减少输血需求。应设计一项样本量充足的前瞻性随机试验，以阐明在这种情况下使用TXA的风险和益处。
四级。
