Pfister Robin M, Pfister Benjamin F, Hager Ronald L, Sandholtz Nathan, Abulafia Daniel, Bradshaw David
Hunter New England Health District, New Lambton Heights, NSW, 2305, Australia.
Central Coast Local Health District, Gosford, NSW, 2295, Australia.
J Orthop Surg Res. 2025 Jan 30;20(1):111. doi: 10.1186/s13018-025-05475-y.
The use of intravenous tranexamic acid (TXA), an antifibrinolytic agent, has been shown to effectively reduce total blood loss and transfusion rates in total knee arthroplasty (TKA). The aim of this paper is to evaluate the implementation lag and clinical uptake of the use of TXA for primary TKA after publication of two landmark studies. Additionally, it assessed the efficacy of TXA use in TKA in reducing post-operative blood transfusions and hospital length of stay (LOS).
A total of 763 patients aged over 18 years of age underwent primary TKA at a level 4 metropolitan hospital in Australia between January 2011 and December 2017. Primary outcome measure was use of TXA at operative induction. Secondary outcome measures were post-operative blood transfusion, haemoglobin levels and in-hospital length of stay.
The rate of TXA uptake was ≥ 50% by April-June 2013, 1.5 years following landmark paper publication. TXA use was ≥ 90% by April-June 2015, equating to 3.5 years after landmark publication. For each additional year since publication, the odds that TXA was used in a TKA surgery increased by 254.3%, 95% CI (confidence interval) [195.2%, 334.1%]. There was a negative association between TXA use and blood transfusion rate (p < 0.001), while controlling for other variables. TXA use reduced the odds of blood transfusions occurring by 73.5%, 95% CI [35.8% and 89.8%]. Analysis showed that reduced LOS was seen even after controlling for post-operative blood transfusion (p < 0.05).
The implementation lag from research to clinical practice, using ≥ 90% TXA use in TKA as a proxy, was 3.5 years. The use of TXA reduced LOS and blood transfusion rate in TKA patients.
抗纤维蛋白溶解剂静脉注射氨甲环酸（TXA）已被证明可有效减少全膝关节置换术（TKA）中的总失血量和输血率。本文旨在评估两项具有里程碑意义的研究发表后，TXA用于初次TKA的实施延迟和临床应用情况。此外，还评估了TXA在TKA中减少术后输血和住院时间（LOS）的疗效。
2011年1月至2017年12月期间，澳大利亚一家四级城市医院共有763名18岁以上的患者接受了初次TKA。主要结局指标是手术诱导时使用TXA。次要结局指标是术后输血、血红蛋白水平和住院时间。
在具有里程碑意义的论文发表1.5年后，即2013年4月至6月，TXA的使用率≥50%。到2015年4月至6月，TXA的使用率≥90%，相当于里程碑发表后3.5年。自发表以来的每增加一年，TKA手术中使用TXA的几率增加254.3%，95%置信区间（CI）[195.2%，334.1%]。在控制其他变量的情况下，TXA的使用与输血率之间存在负相关（p<0.001）。TXA的使用使输血发生的几率降低了73.5%，95%CI[35.8%和89.8%]。分析表明，即使在控制术后输血后，住院时间也有所缩短（p<0.05）。
以TKA中≥90%的TXA使用率为代表，从研究到临床实践的实施延迟为3.5年。TXA的使用降低了TKA患者的住院时间和输血率。
