Sawant Sharad, Deshpande Sanjay V, Wamborikar Hitendra, Jadawala Vivek H, Suneja Anmol, Goel Sachin, Patel Vatsal
Department of Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Cureus. 2024 Jul 25;16(7):e65386. doi: 10.7759/cureus.65386. eCollection 2024 Jul.
Total knee arthroplasty (TKA) is a widely performed surgical procedure to restore function and relieve pain in patients with advanced knee arthritis. One of the key challenges in TKA is managing perioperative blood loss, which can lead to complications such as postoperative anemia and the need for blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promising results in reducing blood loss and transfusion requirements in various surgical settings, including TKA. This comprehensive review synthesizes current evidence regarding the efficacy and safety profile of TXA in primary TKA. Mechanistically, TXA functions by inhibiting the breakdown of fibrin clots, promoting hemostasis, and minimizing blood loss. Clinical studies evaluating TXA in TKA have consistently demonstrated significant reductions in blood loss parameters, including total blood loss, postoperative drain output, and transfusion rates. Key findings highlight the efficacy of TXA across different dosing regimens and administration routes, with minimal associated risks of thromboembolic events or adverse effects. Comparative analyses with other blood conservation strategies underscore TXA's superiority in reducing transfusion requirements and its cost-effectiveness in clinical practice. The review also discusses current clinical guidelines and recommendations for TXA use in TKA, emphasizing optimal dosing strategies and patient selection criteria. Future research directions include exploring the long-term outcomes of TXA administration and its impact on functional recovery, and refining protocols to enhance its efficacy and safety further. In conclusion, TXA represents a valuable adjunct in blood loss management during primary TKA, offering substantial benefits in patient outcomes, healthcare resource utilization, and cost-effectiveness. Continued research efforts are warranted to optimize its use and expand its applicability in orthopedic surgery.
全膝关节置换术（TKA）是一种广泛开展的外科手术，用于恢复晚期膝关节关节炎患者的功能并缓解疼痛。TKA的关键挑战之一是处理围手术期失血，这可能导致诸如术后贫血和输血需求等并发症。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，在包括TKA在内的各种手术环境中，已显示出在减少失血和输血需求方面有令人鼓舞的结果。这篇综述综合了关于TXA在初次TKA中疗效和安全性的现有证据。从机制上讲，TXA通过抑制纤维蛋白凝块的分解、促进止血和减少失血来发挥作用。评估TKA中TXA的临床研究一致表明，失血参数显著降低，包括总失血量、术后引流量和输血率。主要研究结果突出了TXA在不同给药方案和给药途径中的疗效，血栓栓塞事件或不良反应的相关风险最小。与其他血液保护策略的比较分析强调了TXA在减少输血需求方面的优越性及其在临床实践中的成本效益。该综述还讨论了目前TKA中使用TXA的临床指南和建议，强调了最佳给药策略和患者选择标准。未来的研究方向包括探索TXA给药的长期结果及其对功能恢复的影响，以及完善方案以进一步提高其疗效和安全性。总之，TXA是初次TKA失血管理中的一种有价值的辅助药物，在患者预后、医疗资源利用和成本效益方面具有显著益处。有必要继续开展研究工作，以优化其使用并扩大其在骨科手术中的适用性。
