在膝关节翻修手术中，与固定剂量方案相比，基于体重的氨甲环酸可降低术后失血风险和输血需求：一项比较研究。
Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study.
作者信息
Yang Chenchen, Ji Baochao, Li Guoqing, Zhang Xiaogang, Xu Boyong, Maimaitiming Askar, Cao Li
机构信息
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, 830054, Xinjiang, China.
Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, 137 South LiYuShan Road, Urumqi, 830054, Xinjiang, China.
出版信息
J Orthop Traumatol. 2025 May 2;26(1):26. doi: 10.1186/s10195-025-00844-z.
BACKGROUND
Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1-2 g) to weight-based protocols (e.g., 10-20 mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA).
MATERIALS AND METHODS
This retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1 g TXA before skin incision and a topical application of 1 g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20 mg/kg/h TXA intravenously and a topical application of 1 g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications.
RESULTS
The weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22 g/L versus 26.09 g/L, p < 0.001) and fixed-dose TXA (18.22 g/L versus 24.69 g/L, p < 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (p < 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (p = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (p = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all p > 0.05).
CONCLUSIONS
Weight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements.
LEVEL OF EVIDENCE
Level 3, non-randomized observational study.
背景
不同研究中静脉注射氨甲环酸（TXA）的给药方案差异很大，从固定剂量（如1 - 2克）到基于体重的方案（如10 - 20毫克/千克）不等。本研究旨在比较翻修全膝关节置换术（rTKA）中固定剂量和基于体重的TXA方案在术后失血量、输血率、住院死亡率及并发症方面的差异。
材料与方法
这项回顾性比较研究纳入了2004年6月至2024年5月期间接受rTKA的298例患者。患者分为三组：（1）未使用TXA组；（2）固定剂量TXA组，患者在皮肤切开前静脉输注1克TXA并局部应用1克；（3）基于体重的TXA组，患者静脉接受按体重调整剂量的20毫克/千克/小时TXA并局部应用1克。我们分析了血红蛋白（Hb）水平的最大降幅、术后输血率以及住院死亡率和并发症的发生率。
结果
与未使用TXA组（18.22克/升对26.09克/升，p < 0.001）和固定剂量TXA组（18.22克/升对24.69克/升，p < 0.001）相比，基于体重的TXA组Hb的最大降幅更低。固定剂量TXA组和基于体重的TXA组术后输血率均低于未使用TXA组（p < 0.001）。基于体重的TXA组术后输血率低于固定剂量TXA组（p = 0.022）。尽管三组之间深静脉血栓形成（DVT）的发生率有统计学意义（p = 0.038），但组间两两比较未显示出统计学上的显著差异（所有p > 0.05）。
结论
与固定剂量TXA方案相比，基于体重的TXA剂量显著减少了rTKA术后的失血量和输血需求。应考虑采用基于体重的TXA方案以有效减少术后失血量并降低输血需求。
证据水平
3级，非随机观察性研究。
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