Ju Yucan, Liu Huansheng, Jiang Wenyu, Huang Qiang, Zhou Zongke, Pei Fuxing
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, The People's Republic of China.
J Orthop Surg Res. 2025 May 13;20(1):457. doi: 10.1186/s13018-025-05867-0.
Total knee arthroplasty (TKA) has significant perioperative blood loss and a high transfusion rate. Tranexamic acid (TXA) has widely recognized hemostatic efficacy in TKA. Hemocoagulase Agkistrodon (HCA) enhances coagulation by hydrolyzing fibrinogen into fibrin, complements the hemostatic effect of TXA. Our aim was to investigate the hemostatic potential of sequential administration of HCA and TXA in TKA.
Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive the sequential administration of HCA and TXA (n = 29) or TXA-only (n = 30. All patients received mechanical and chemical thromboprophylaxis protocol. The primary outcome was perioperative blood loss, while secondary outcomes were postoperative coagulation function and arterio-venous thrombosis, transfusion, and complications.
Total blood loss was not different between sequential administration of HCA and TXA group (1,025.3 ± 305.3 mL) and TXA-only group (892.4 ± 306.4 mL, P = 0.079). Intermuscular vein thrombosis was reported in one case in the sequential administration group and three cases in the TXA-only group. No deep vein thrombosis was reported in any of the patients. The two groups had no perioperative transfusion.
The sequential administration of HCA and TXA does not demonstrate superior efficacy in reducing blood loss compared to TXA-only. However, the HCA and TXA group has a lower incidence of intermuscular thrombosis and may demonstrate superiority in postoperative thromboprophylaxis.
全膝关节置换术（TKA）围手术期失血量大且输血率高。氨甲环酸（TXA）在TKA中具有广泛认可的止血效果。尖吻蝮蛇血凝酶（HCA）通过将纤维蛋白原水解为纤维蛋白来增强凝血，补充TXA的止血作用。我们的目的是研究在TKA中序贯使用HCA和TXA的止血潜力。
在我院接受骨水泥型全膝关节置换术的患者被随机分为接受HCA和TXA序贯给药组（n = 29）或仅接受TXA组（n = 30）。所有患者均接受机械和化学血栓预防方案。主要结局是围手术期失血，次要结局是术后凝血功能、动静脉血栓形成、输血及并发症。
HCA和TXA序贯给药组的总失血量（1,025.3±305.3 mL）与仅接受TXA组（892.4±306.4 mL，P = 0.079）无差异。序贯给药组有1例报告发生肌间静脉血栓形成，仅接受TXA组有3例。所有患者均未报告深静脉血栓形成。两组围手术期均未输血。
与仅使用TXA相比，序贯使用HCA和TXA在减少失血方面未显示出更优的疗效。然而，HCA和TXA组肌间血栓形成的发生率较低，可能在术后血栓预防方面表现出优势。
