Khatib Yasser, Bal Gobind, Liu Rui, Ashaia Wagdy, Sorial Rami
Nepean Hospital, The School of Medicine Nepean, The University of Sydney, PO Box 949, Penrith, NSW, 2750, Australia.
Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia.
Arch Orthop Trauma Surg. 2024 Jul;144(7):3095-3102. doi: 10.1007/s00402-024-05325-2. Epub 2024 Jun 7.
Intravenous tranexamic acid (TA) has proven efficacy in reducing blood loss and incidence of transfusion of blood products in elective total joint arthroplasty. However, evidence of efficacy in the setting of intracapsular hip fractures needing hip hemiarthroplasty (HA) or total hip arthroplasty (THA) are scarce. This study aimed to assess post-operative transfusion incidence in this clinical setting.
Over a five-year period 250 patients with intracapsular neck of femur fractures requiring arthroplasty were randomised to two groups. The treatment group received three-dose intravenous TA protocol and the control group received usual treatment without administration of TA. Blood loss was estimated from the change in Hb levels on day 1, 3 and 5 after surgery compared to preoperative levels. Transfusions of blood products were recorded when they were triggered by an a priori protocol. Post-operative complications were recorded during patient hospital admission.
The intervention group showed significantly lower transfusion incidence of packed red blood cells (PRBC) (6 vs. 15, p = 0.04, OR = 0.37, 95%CI OR = 0.14 to 0.99) and in the group of patients who received a blood transfusion, a trend was observed for patients who received TA to have lesser number of units of PRBC (mean = 1.3 vs. 1.6, p = 0.51). A significant difference was noted in post-operative Hb levels of day 1,3 and 5. Backward stepwise multivariable regression analysis showed the use of TA was the most significant factor for reduction in postoperative blood transfusion (p = 0.047, OR = 0.37, 95% CI OR = 0.14 to 0.99). Assessment of the strength of the correlation showed modest correlation (Pearson correlation - 0.13 p = 0.04, 95% CI correlation= -0.25 to -0.01). There was no increase in adverse events in patients who received TA.
The use of TA in setting of intracapsular hip fractures requiring arthroplasty reduces blood loss, the need for transfusion of blood products and may reduce surgical site complications without increasing the risk of VTE.
静脉注射氨甲环酸（TA）已被证明在择期全关节置换术中可有效减少失血及输血制品的发生率。然而，在需要进行髋关节半关节置换术（HA）或全髋关节置换术（THA）的囊内髋部骨折患者中，其疗效证据却很稀少。本研究旨在评估这一临床情况下的术后输血发生率。
在五年期间，将250例需要进行关节置换术的股骨颈囊内骨折患者随机分为两组。治疗组接受三剂量静脉注射TA方案，对照组接受不使用TA的常规治疗。根据术后第1天、第3天和第5天血红蛋白（Hb）水平相对于术前水平的变化来估计失血量。当根据预先设定的方案触发输血时，记录输血制品的情况。在患者住院期间记录术后并发症。
干预组的浓缩红细胞（PRBC）输血发生率显著较低（6例 vs. 15例，p = 0.04，OR = 0.37，95%CI OR = 0.14至0.99），并且在接受输血的患者组中，观察到接受TA的患者有较少单位PRBC的趋势（平均值 = 1.3 vs. 1.6，p = 0.51）。术后第1天、第3天和第5天的Hb水平存在显著差异。向后逐步多变量回归分析表明，使用TA是减少术后输血的最显著因素（p = 0.047，OR = 0.37，95%CI OR = 0.14至0.99）。相关性强度评估显示为适度相关（Pearson相关性 -0.13，p = 0.04，95%CI相关性 = -0.25至-0.01）。接受TA的患者不良事件没有增加。
在需要进行关节置换术的囊内髋部骨折患者中使用TA可减少失血、减少输血制品的需求，并可能减少手术部位并发症，而不会增加静脉血栓栓塞（VTE）的风险。
