Hemostatic and Anti-Inflammatory Effects of Carbazochrome Sodium Sulfonate in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundPostoperative recovery after total knee arthroplasty (TKA) is associated with postoperative anemia, allogeneic transfusion, and stress immune responses to surgery. Carbazochrome sodium sulfonate (CSS) reduces bleeding through several mechanisms. We assessed the effect of CSS combined with tranexamic acid (TXA) on postoperative anemia, blood transfusion, and inflammatory responses.MethodsThis study was designed as a randomized, placebo-controlled trial of 200 patients undergoing unilateral primary TKA. Patients were divided into 4 groups: group A received TXA plus topical and intravenous CSS; group B received TXA plus topical CSS only; group C received TXA plus intravenous CSS only; group D received TXA only.ResultsTotal blood loss in groups A (609.92 ± 221.24 mL), B (753.16 ± 247.67 mL), and C (829.23 ± 297.45 mL) was lower than in group D (1158.26 ± 334.13 mL, P < .05). There was no difference in total blood loss between groups B and C. We also found that compared with group D, the postoperative swelling rate, biomarker level of inflammation, visual analog scale pain score, and range of motion at discharge in groups A, B, and C were significantly improved (P < .05). No thromboembolic complications occurred. There were no differences in transfusion rate, intraoperative blood loss, platelet count, or average length of stay among the 4 groups (P > .05).ConclusionCSS combined with TXA was more effective than TXA alone in reducing perioperative blood loss and inflammatory response and did not increase the incidence of thromboembolism complications.     

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty

The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3 g TXA per 100 mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.     

The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized,Controlled Trial

Background

Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA.

Repeat-dose intravenous tranexamic acid further decreases blood loss in total knee arthroplasty

Purpose

Tranexamic acid (TXA) reduces blood loss in patients undergoing total knee arthroplasty (TKA). However, few studies have reported the optimum timing and dosage for administration of TXA. The purpose of this study was to evaluate the effect of repeat-dose TXA on blood loss during TKA and the necessity of autologous blood donation or postoperative autotransfusion.

Methods

We enrolled 78 patients with primary osteoarthritis undergoing cemented TKAs. Consecutive patients were divided into three groups, as follows: control group (n = 31), single-TXA group (n = 21) in whom TXA (1,000 mg) was intravenously administered 10 min before deflation of the tourniquet, and twice-TXA group (n = 26) in whom TXA (1,000 mg) was intravenously administered 10 min before deflation of the tourniquet and 3 h after the operation. We measured the volume of drained blood after the operation. Haemoglobin (Hb) levels were measured at days 1, 4 and 7 postoperation. Venous thromboembolic events (VTE) were screened using compression ultrasonography at enrollment and 1 and 7 days after operation.

Results

The mean volume of drained blood after the operation was lower in the twice-TXA group than in the single-TXA (p < 0.001) and control (p < 0.0001) groups. No significant differences were observed in the incidence of VTE between these groups.

Conclusion

Administration of TXA twice reduced postoperative blood loss after TKA, and TXA was not associated with the risk of deep-vein thrombosis (DVT) or pulmonary embolism (PE). Further, administration of TXA twice may eliminate the need for blood transfusion during TKA.     

Topical hemostatic procedures control blood loss in bilateral cemented single-stage total knee arthroplasty

Background Blood management is critical in total knee arthroplasty (TKA). In bilateral, single stage TKA, blood loss seems more prominent. We believe it is important to control all potential bleeding within the wound tissue.Purpose The purpose of the study was to evaluate a series of topical procedures used to reduce blood loss and transfusion in single-stage bilateral cemented total knee arthroplasty: antifibrinolysis with tranexamic acid, vasoconstriction with epinephrine, sealing of the bone section intraoperatively, and closure of the drainage tube within the first 4 h postoperatively.Materials and methods Patients with osteoarthritis of the knees were randomly divided into two groups. In group A, 5 ml (25 mg/ml) tranexamic acid (TXA) and 5 ml analgesic containing epinephrine (3 μg/ml) solution were injected at several points into the posterior capsule before installation of the prosthesis. The femoral medullar canal was closed with autograft bone and then sealed compressively with cement. Before the tourniquet was released, 10 ml TXA solution and 10 ml analgesic containing epinephrine were injected at several points into the periosteum, synovium, joint capsule, tendons, and deep fascia tissue (injection of analgesic containing epinephrine into subcutaneous fat and dermis was avoided). The residual nail holes in the bone and the uncovered bone section were covered with bone wax. The tourniquet was then removed, and active bleeding points were stanched. TXA solution (20 ml) was injected into the articular cavity after wound closure. The drainage tube was clamped for 4 h, then opened. In group B, injection of analgesic containing epinephrine into soft tissue, control of active bleeding, and clamping of the drainage tube for 4-h, only, were performed.Results Ninety patients were enrolled in the study. Compared with those in group B, intraoperative blood loss, drainage volume, total postoperative blood loss, and number of patients requiring allogenic blood transfusion were significantly reduced in group A. There was no significant difference between the incidence of complications in the groups.Conclusions Our topical procedures enable effective and safe reduction of blood loss and the number of patients requiring transfusion in single-stage bilateral osteoarthritic TKA.     

Periarticular Injection of Tranexamic Acid Reduces Blood Loss and the Necessity for Allogeneic Transfusion After Total Knee Arthroplasty Using Autologous Transfusion: A Retrospective Observational Study

Background

This study aimed to examine the influence of a periarticular injection of tranexamic acid (TXA) on blood loss after a total knee arthroplasty (TKA) in patients who received an autologous blood transfusion.

Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage

Background:

Tranexamic acid (TEA) reduces blood loss and red cell transfusions in patients undergoing unilateral total knee arthroplasty (TKA). However, there is not much literature regarding the use of TEA in patients undergoing bilateral TKA in a single stage and the protocols for administration of TEA in such patients are ill-defined.

Materials and Methods:

We carried out a case control study evaluating the effect of TEA on postoperative hemoglobin (Hb), total drain output, and number of blood units transfused in 52 patients undergoing bilateral TKA in a single stage, and compared it with 56 matched controls who did not receive TEA. Two doses of TEA were administered in doses of 10 mg / kg each (slow intravenous (IV) infusion), with the first dose given just before tourniquet release of the first knee and the second dose three hours after the first one.

Results:

A statistically significant reduction in the total drain output and requirement of allogenic blood transfusion in cases who received TEA, as compared to the controls was observed. The postoperative Hb and Hb at the time of discharge were found to be lower in the control group, and this result was found to be statistically significant.

Conclusion:

TEA administered in patients undergoing single stage bilateral TKA helped reduce total blood loss and decreased allogenic blood transfusion requirements. This might be particularly relevant, where facilities such as autologous reinfusion might not be available.     

氨甲环酸减少全膝关节置换术失血量的Meta分析

目的 通过Meta分析评价抗纤溶药物氨甲环酸(tranexamic acid,TXA)对全膝关节置换术失血量的影响.方法 计算机检索数据库MEDLINE(1966年至2008年8月)、PubMed(1966年至2008年8月)、EMBASE(1966年至2008年8月)、Cochrane图书馆(2008年第3期)、中国生物医学光盘数据库(1978年至2008年8月)、中国生物医学文献数据库(1978年至2008年8月)和维普中文科技期刊数据库(1978年至2008年8月)中关于TXA减少全膝关节置换术出血量的临床随机对照研究,并查阅所有检出文献和相关综述的参考文献作为补充资料,截止到2008年8月.采用RevMan 4.3软件进行统计分析,TXA组与安慰剂组总失血量和输血单位采用加权均数差评价,输血率、深静脉血栓和肺栓塞症发生率采用优势比评价.结果 共纳入前瞻性随机对照研究8篇.Meta分析结果显示,与安慰剂组比较TXA能够减少全膝关节置换患者总出血量(加权均数差值-542.11,95%置信区间[-723.20,-361.01],P<0.001)和输血单位(加权均数差值-1.33,95%置倩区间[-1.70,-0.97],P<0.001),降低输血率(优势比0.11,95%置信区间[0.06,0.18],P<0.001),而深静脉血栓和肺栓塞症发生率差异无统计学意义.结论 静脉注射TXA能够减少全膝关节置换手术失血量和输血单位,降低输血率,不增加深静脉血栓和肺栓塞症的发生风险.     

Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

The objective of this systematic review and meta‐analysis was to evaluate the efficacy and safety of i.v. tranexamic acid (TXA) in simultaneous bilateral total knee arthroplasty (TKA). Potentially relevant published reports were identified from the following electronic databases: Medline, PubMed, Embase, ScienceDirect and Cochrane Library. RevMan v5.3was used to pool data. Two randomized controlled trials and four case‐control studies met the inclusion criteria. The current meta‐analysis identified significant differences between TXA group and control groups in terms of postoperative hemoglobin concentration (P < 0.01), drainage volume (P < 0.01), transfusion rate (P < 0.01) and units transfused (P = 0.006). There were no significant differences in length of stay (P = 0.66), operation time (P = 0.81) or and incidence of adverse effects such as infection (P = 0.42), deep venous thrombosis (DVT) (P = 0.88) and pulmonary embolism (PE) (P = 0.11). Our results show that i.v. administration of TXA in simultaneous bilateral TKA reduces postoperative drops in hemoglobin concentration, drainage volume, and transfusion requirements and does not prolong length of stay or operation time. Moreover, no adverse effects, such as infection, DVT or PE, were associated with TXA.     

局部应用氨甲环酸减少全膝关节置换术后失血量的系统评价

目的采用Meta分析评价局部应用氨甲环酸（TXA）对全膝关节置换（TKA）术后失血量的影响。方法计算机检索Corhrane图书馆、Medline、Embase、中国生物医学文献数据库、维普数据库中关于局部应用TXA减少TKA术后出血量的随机对照研究（RCT）。采用RevMan5．0．24软件进行统计分析,TXA组与对照组总失血量、引流量、血红蛋白下降值、D-二聚体和术后KSS功能评分采用加权均数差评价,输血率采用优势比评价。结果最终共纳入8篇RCT。Meta分析结果显示,与对照组比较,局部应用TXA能够减少TKA术后总出血量[WMD=-302．05,95％CI（-345．05,-259．05）,P〈0．001]及引流量[WMD=-253．70,95％CI（-293．75,-213．65）,P〈0．001],血红蛋白下降较少[WMD=-0．64,95％CI（-0．85,-0．43）,P〈0．001）,降低输血率[OR=0．29,95％CI（0．17,0．48）,P〈0．001]。结论局部应用TXA可以减少TKA术后失血量及引流量,降低输血率。     

前瞻性随机对照研究全膝关节置换术中使用氨甲环酸的临床疗效

目的探讨全膝关节置换（TKA）术中使用氨甲环酸（TXA）的有效性和安全性。方法2010年3月至2013年3月,对88例（88膝）行初次TKA术的退变性骨关节炎患者进行前瞻性、随机化研究。患者随机分为使用TXA（TXA组）和使用安慰剂（对照组）两组。TXA组,在松止血带前15 min静脉给予15 mg/kg剂量的TXA;对照组给予等量的生理盐水。共11例失访（TXA组,5例;对照组,6例）,剩下77例（TXA组,39例;对照组38例）患者纳入最终分析,对其术中失血量、术后24 h引流量、总引流量、隐性失血量、总失血量、输血量、和术后第3天血红蛋白,术后24 h D-二聚体,下肢瘀斑发生率、深静脉血栓（DVT）发生率进行评估。结果两组患者术前一般资料如年龄（t=0.390,P〉0.05）、性别比（Х^2=0.127,P〉0.05）、合并疾病（Х^2=0.142,P〉0.05）等差异均无统计学意义,具有可比性。TXA组术后24 h引流量（t=6.512,P〈0.01）、总引流量（t=4.913,P〈0.01）、隐性失血量（t=5.980,P〈0.01）、总失血量（t=5.808,P〈0.01）、24 h D-二聚体值（t=18.401,P〈0.01）均明显低于对照组;TXA组术后第3天血红蛋白量明显高于对照组（t=4.815,P〈0.01）;TXA组和对照组分别有3例（共1200 ml）和4例（共1400 ml）患者接受异体输血（P〉0.05）。TXA组和对照组下肢远端深静脉血栓均为3例（P〉0.05）。TXA组下肢瘀斑发生率明显低于对照组（2.6%vs.18.4%,P〈0.05）。结论静脉使用TXA,能够安全有效的减少TKA围手术期失血量,不增加深静脉血栓的风险。     

Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study

IntroductionOpen reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial.Material and methodsSixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated.ResultsBoth groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups.ConclusionThere is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures.     

Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study

AIM: To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.METHODS: This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.RESULTS: The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.CONCLUSION: Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.     

The administration of tranexamic acid for corrective surgery involving eight or more spinal levels: A systematic review and meta-analysis

As the number of fusion levels increases, the complexity of spinal correction surgery also increases. Thus, we conducted this study to determine the safety and efficacy of tranexamic acid (TXA) involving eight or more spinal fusion levels. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, a search of the PubMed, Embase, CENTRAL, Web of Science, and ClinicalTrials.gov databases was conducted for relevant studies published prior to May 30, 2019. The primary outcomes, including blood loss and transfusion requirement, and the secondary outcomes, including general indices, postoperative hemoglobin, and coagulation function, were analyzed using Rev Man 5.3.5 software and STATA version 12.0. Eight randomized controlled trials (473 participants) were included in the study. Compared to the control treatments, TXA reduced intraoperative blood loss, total blood loss, transfusion volume, and prothrombin time. There were no significant differences between the TXA and non-TXA groups in transfusion rate, operative time, hospital stay, complications, hemoglobin level, and other coagulation function parameters. In the pediatric subgroup analysis, TXA additionally improved hemoglobin levels, platelet count, and prothrombin time international normalized ratio. The present meta-analysis showed that TXA reduced blood loss and transfusion volume in both adults and children. In pediatric patients, TXA led to a greater benefit in postoperative hemoglobin levels and coagulation function. Intravenous TXA is safe and effective in children with eight or more spinal corrective levels.     

氨甲环酸对全膝关节置换术失血量的影响

目的：探讨氨甲环酸静脉重复剂量给药对全膝关节置换术失血量的影响及安全性评估。方法：对2011年4月-2012年4月90例初次行单侧全膝关节置换术的患者资料进行回顾性分析,其中男性32例,女性58例。90例患者被随机分为3组,（A组）对照组30例：（B组）单次剂量组30例：术中松止血带前10min1000mg氨甲环酸静脉滴注;（C组）双次剂量组30例：分别于术中松止血带前10min、术后3h各1000mg氨甲环酸静脉滴注。记录术后48h引流量、隐性失血量、术后12h血红蛋白减少量、输血量,术后14天观察患者是否出现下肢深静脉栓塞症状。结果：术后引流量、隐性失血量单次剂量组及双次剂量组明显低于对照组（P〈0．05）,其中双次剂量组最低。术后12h血红蛋白保持水平单次剂量组及双次剂量组明显高于对照组（P〈0．05）,术后输血量双次剂量组明显低于单次剂量组和对照组（P〈0．05）,所有患者术后14天彩色多普勒检查未发现下肢深静脉血栓形成。结论：氨甲环酸重复剂量给药可以显著减少全膝关节置换术后失血量,氨甲环酸并没有增加术后下肢深静脉血栓及肺栓塞的风险,另外,重复剂量给药可以显著减少全膝关节置换术患者的输血量。     

Postoperative Intravenous Iron Supplementation Does Not Improve Hemoglobin Level and Transfusion Rate Following Staged Bilateral Total Knee Arthroplasty

BackgroundWe determined whether postoperative intravenous (IV) iron supplementation could reduce transfusion rate in patients undergoing staged bilateral total knee arthroplasty (TKA). Furthermore, we examined whether hemoglobin (Hb) levels and iron profile differed between patients with and without postoperative IV iron supplementation.MethodsThis retrospective, comparative cohort study included 126 patients who underwent primary staged bilateral TKA during a single hospitalization. The second TKA was performed at a week’s interval. Group iron (n = 65) received IV iron immediately after each surgery, while patients in group no-iron (n = 61) received no iron after surgery. Transfusion rate, change in Hb levels, and iron profile including serum iron, ferritin, total iron binding capacity, and transferrin saturation were evaluated preoperatively; on postoperative days 1, 2, and 4 after the first TKA; and postoperative days 1, 2, 4, and 7, 6 weeks, and 3 months after the second TKA.ResultsThere were no significant differences in Hb levels and transfusion rate following staged bilateral TKA between patients with and without postoperative IV iron supplementation although serum iron profiles were improved in patients with IV iron supplementation.ConclusionPostoperative IV iron supplementation immediately after acute blood loss caused by TKA was not effective in improving the transfusion rate. Therefore, surgeons should use protocols other than postoperative IV iron supplementation for reducing the transfusion rate in patients undergoing staged bilateral TKA in a single hospitalization.Level of EvidenceIII.     

Comparison of 3 Routes of Administration of Tranexamic Acid on Primary Unilateral Total Knee Arthroplasty: A Prospective,Randomized, Controlled Study

Background

The mode of administration for tranexamic acid (TXA) to significantly reduce the decrease in hemoglobin (Hb), number of transfusions, relevant costs, and side effects in patients undergoing primary unilateral total knee arthroplasty (TKA) has not been resolved.

An Aprotinin Containing Fibrin Sealant Does Not Reduce Blood Loss in Total Hip Arthroplasty

Background

Fibrin sealants are topical agents used to reduce perioperative blood loss; however, their efficacy in total hip arthroplasty (THA) remains uncertain. The purpose of this study was to determine if a fibrin sealant containing aprotinin as an antifibrinolytic agent, TISSEEL (Baxter, Deerfield, IL), reduces postoperative blood loss and transfusion during THA when compared with intravenous (IV) tranexamic acid (TXA) and control groups.

Blood Management Following Total Joint Arthroplasty in an Aging Population: Can We Do Better?

BackgroundTo evaluate the transfusion rates for octogenarians and nonagenarians following total knee and hip arthroplasty (TKA, THA), we compared transfusion rates and associated risk factors among sexagenarians, septuagenarians, octogenarians, and nonagenarians.MethodsThis retrospective cohort study included 13,603 sexagenarians, 9796 septuagenarians, 2706 octogenarians, and 158 nonagenarians that received a primary, unilateral THA or TKA between 2016 and 2020 at a high-volume institution. Using multivariable logistic regression analysis, the study analyzed risk factors for postoperative transfusions including use of tranexamic acid (TXA) and compared preoperative and postoperative hemoglobin (Hgb) levels and the drop in Hgb.ResultsNonagenarians had significantly higher transfusion rates (THA 25.5%, TKA 26.7%) than octogenarians (THA 9.9%, TKA 9.2%), septuagenarians (THA 3.3%, TKA 4.5%), and sexagenarians (THA 1.9%, TKA 2.9%) (P < .01). Significant risk factors for transfusion requirement following THA were American Society of Anesthesiologists level III (odds ratio [OR] 5.3, P < .01) and American Society of Anesthesiologists level IV (OR 8.0, P = .01), nonuse of TXA (intravenous: OR 0.3, P < .01; topical: OR 0.5, P < .01), lower preoperative Hgb levels (OR 0.4, P < .01), longer duration of surgery (OR 1.0, P < .01), and hepatopathy (OR 3.1, P < .01). Significant risk factors following TKA were nonuse of TXA (intravenous: OR 0.3, P < .01; topical: OR 0.5, P < .01; combined: OR 0.2, P < .01), lower preoperative Hgb levels (OR 0.4, P < .01), and longer surgery time (OR 1.0, P < .01).ConclusionThe strongest independent risk factors for increased transfusion rates among octogenarians and nonagenarians were lack of TXA application and lower preoperative Hgb levels. Routine TXA application and preoperative patient optimization are recommended to reduce transfusion rates in patients aged 80+.     

氨甲环酸在全膝关节置换术中应用策略的研究进展

氨甲环酸作为一种抗纤维蛋白溶解药用于减少全膝关节置换术中术后失血量是近年来研究的热点问题,对全膝关节置换术后患者的失血量、血红蛋白含量、输血率等其他相关指标的影响被大量学者研究及探讨。但如何安全、有效地应用氨甲环酸,目前还没有一种金标准策略。根据不同的用药剂量,氨甲环酸可以按药物体重比例使用或直接1.5 g或3.0 g使用;根据不同的给药途径,氨甲环酸可以静脉滴注、局部应用以及口服用药;根据不同的使用时机,氨甲环酸可以术前、术中、术后或联合使用。在不增加全膝关节置换术后血栓形成概率的条件下,选择更为科学的使用方法来发挥氨甲环酸的最大效用,是近来研究的热点。