Liangliang Luo, Wei Huang, Tao Zhang, Pin Pan, Lianying Hu
Department of Orthopedics, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
Front Med (Lausanne). 2025 Jun 3;12:1552893. doi: 10.3389/fmed.2025.1552893. eCollection 2025.
This retrospective study evaluates the efficacy and safety of tranexamic acid (TXA) in reducing hidden blood loss during unilateral total knee arthroplasty (TKA) in patients with osteoarthritis. As the aging population leads to a rise in degenerative knee joint diseases, TKA has become a common surgical intervention. However, it is often associated with significant hidden blood loss, accounting for 60-75% of total blood loss, which can result in complications such as anemia and increased transfusion needs. Our study included 123 patients who underwent TKA between June 2019 and June 2022, divided into an observation group receiving TXA and a control group receiving saline. TXA was administered intravenously before surgery and locally into the joint cavity post-incision. The study found that TXA significantly reduced total blood loss by 37.4%, with a notable decrease in hidden blood loss ( < 0.05). The TXA group also exhibited lower transfusion rates (27.4 vs. 45.9%, = 0.033) and reduced intraoperative blood loss (330.6 ± 25.3 mL vs. 494.4 ± 32.8 mL, < 0.001). Importantly, TXA did not increase the risk of thromboembolic complications, with no significant differences in deep vein thrombosis or pulmonary embolism between the groups. Coagulation parameters remained stable, supporting TXA's safety profile. These findings suggest that TXA is a safe and effective strategy for managing blood loss in TKA, potentially improving patient outcomes, reducing healthcare costs, and optimizing resource utilization.
这项回顾性研究评估了氨甲环酸（TXA）在减少骨关节炎患者单侧全膝关节置换术（TKA）期间隐性失血方面的疗效和安全性。随着人口老龄化导致退行性膝关节疾病增多，TKA已成为一种常见的外科手术干预方式。然而，它常常伴有大量隐性失血，占总失血量的60 - 75%，这可能导致贫血和输血需求增加等并发症。我们的研究纳入了2019年6月至2022年6月期间接受TKA的123例患者，分为接受TXA的观察组和接受生理盐水的对照组。TXA在手术前静脉注射，并在切口后局部注入关节腔。研究发现，TXA显著减少了37.4%的总失血量，隐性失血显著减少（<0.05）。TXA组的输血率也较低（27.4%对45.9%，=0.033），术中失血量减少（330.6±25.3 mL对494.4±32.8 mL，<0.001）。重要的是，TXA没有增加血栓栓塞并发症的风险，两组之间深静脉血栓形成或肺栓塞没有显著差异。凝血参数保持稳定，支持TXA的安全性。这些发现表明，TXA是一种安全有效的TKA失血管理策略，可能改善患者预后、降低医疗成本并优化资源利用。
