Li Yu-Yu, Yu Ting-Sian, Ho Chun-Ning, Lai Yi-Chen, Yew Ming, Yu Chia-Hung, Hung Kuo-Chuan
Department of Anesthesiology, Chi Mei Medical Center, Chiali, Tainan, Taiwan.
Department of Leisure and Sports Management, CTBC University of Technology, Tainan, Taiwan.
Medicine (Baltimore). 2025 Sep 5;104(36):e44317. doi: 10.1097/MD.0000000000044317.
The safety of tranexamic acid (TXA) in patients with recent coronavirus disease (COVID-19) infection undergoing major arthroplasty remains unclear. We aimed to evaluate whether TXA increases thromboembolic risk in post-COVID-19 patients undergoing major arthroplasty. Using the TriNetX database, we identified patients aged ≥50 years who underwent total knee or hip arthroplasty with documented COVID-19 within 3 months prior to surgery. Patients who received TXA on the day of surgery were compared with those who did not. The primary outcome was 6-month risk of venous thromboembolism (VTE), with secondary outcomes including cerebral infarction, mortality, intensive care unit (ICU) admission, acute kidney injury (AKI), sepsis, and pneumonia. After matching (26,366 patients for each group), analysis revealed that TXA use was not associated with an increased risk of VTE (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.90-1.32, P = .404), cerebral infarction (OR 0.86, 95% CI 0.67-1.09, P = .215), mortality (OR 0.81, 95% CI 0.60-1.10, P = .174), or other complications at 6 months. Notably, TXA was associated with a significantly reduced risk of ICU admissions (OR 0.74, 95% CI 0.62-0.89, P = .001). Sensitivity analysis showed that TXA provided additional benefits in patients with prior COVID-19 hospitalization, including reduced mortality (OR 0.53, P = .003), lower risk of AKI (OR 0.79, P = .002), and decreased incidence of sepsis (OR 0.77, P = .038). Sex-based analysis revealed more pronounced benefits in female patients, particularly for ICU admission and AKI. TXA use in post-COVID patients undergoing major arthroplasty was associated with better long-term outcomes without increasing thromboembolic risk, supporting the continued use of TXA in this patient population.
近期感染新型冠状病毒病（COVID-19）的患者在接受大关节置换术时使用氨甲环酸（TXA）的安全性仍不明确。我们旨在评估TXA是否会增加COVID-19后接受大关节置换术患者的血栓栓塞风险。利用TriNetX数据库，我们确定了年龄≥50岁、在手术前3个月内有COVID-19记录且接受全膝关节或髋关节置换术的患者。将手术当天接受TXA的患者与未接受TXA的患者进行比较。主要结局是6个月时静脉血栓栓塞（VTE）的风险，次要结局包括脑梗死、死亡率、重症监护病房（ICU）入院、急性肾损伤（AKI）、脓毒症和肺炎。匹配后（每组26366例患者），分析显示使用TXA与VTE风险增加无关（比值比[OR]1.09，95%置信区间[CI]0.90-1.32，P = 0.404）、脑梗死（OR 0.86，95%CI 0.67-1.09，P = 0.215）、死亡率（OR 0.81，95%CI 0.60-1.10，P = 0.174）或6个月时的其他并发症。值得注意的是，TXA与ICU入院风险显著降低相关（OR 0.74，95%CI 0.62-0.89，P = 0.001）。敏感性分析表明，TXA对先前因COVID-19住院的患者有额外益处，包括降低死亡率（OR 0.53，P = 0.003）、降低AKI风险（OR 0.79，P = 0.002）以及降低脓毒症发生率（OR 0.77，P = 0.038）。基于性别的分析显示，女性患者的获益更为明显，尤其是在ICU入院和AKI方面。在接受大关节置换术的COVID-19后患者中使用TXA与更好的长期结局相关，且不会增加血栓栓塞风险，这支持在该患者群体中继续使用TXA。
