Kushwaha Narendra S, Singh Shubham, Kumar Sanjiv, Singh Arpit, Abbas Mohammad Baqar, Deshwal Siddharth, Agarwal Rishabh
Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND.
Cureus. 2023 Mar 16;15(3):e36230. doi: 10.7759/cureus.36230. eCollection 2023 Mar.
Background Total hip arthroplasty (THA) is the most successful orthopedic elective surgical procedure for end-stage hip arthritis. THA is linked with significant blood loss, ranging from 1,188 to 1,651 mL, and a transfusion rate of 16-37%, which frequently results in postoperative blood transfusions. Postoperative blood transfusions can be avoided by using autologous blood transfusion, intraoperative blood saving, local anesthetic, hypotensive anesthesia, and antifibrinolytic medications such as tranexamic acid (TXA) administration. Methodology A double-blinded, placebo-controlled, randomized, controlled study was conducted with three prospective groups to investigate the efficacy of topical and systemic routes of a single intraoperative dose (1.5 g) of TXA. Patients were recruited from our center between October 2021 to March 2022 who were undergoing primary total hip replacement. Estimated blood loss was calculated and compared in groups, and a p-value of <0.05 was taken as significant. Results A total of 60 patients were recruited in our study. Estimated blood loss was similar in both treatment groups, 816.8 ± 219.9 mL in the systemic TXA group and 775.5 ± 107.2 mL in the topical TXA group. The placebo group had 1,066.3 ± 150.4 mL estimated blood loss, which was significantly higher compared to the treatment groups. Conclusions Administration of TXA (1.5 g) significantly lowers blood loss without increasing problems, which can eliminate concerns about intravenous TXA use. TXA reduces blood loss by 270 mL on average.
背景 全髋关节置换术（THA）是终末期髋关节炎最成功的骨科择期手术。THA与大量失血有关，失血量在1188至1651毫升之间，输血率为16% - 37%，这常常导致术后输血。通过使用自体输血、术中血液回收、局部麻醉、低血压麻醉以及抗纤维蛋白溶解药物如氨甲环酸（TXA）给药，可以避免术后输血。方法 进行了一项双盲、安慰剂对照、随机对照研究，设有三个前瞻性组，以研究术中单次剂量（1.5克）TXA局部和全身给药途径的疗效。2021年10月至2022年3月期间，从我们中心招募了接受初次全髋关节置换的患者。计算并比较各组的估计失血量，p值<0.05被视为有统计学意义。结果 我们的研究共招募了60名患者。两个治疗组的估计失血量相似，全身TXA组为816.8±219.9毫升，局部TXA组为775.5±107.2毫升。安慰剂组的估计失血量为1066.3±150.4毫升，与治疗组相比显著更高。结论 给予TXA（1.5克）可显著降低失血量且不增加问题，这可以消除对静脉使用TXA的担忧。TXA平均减少失血量270毫升。
