大剂量氨甲环酸降低脊柱结核患者围手术期出血风险

目的探讨预防性应用大剂量氨甲环酸能否有效减少脊柱结核围手术期出血及相关不良事件。方法选择本院2016年1月-2018年12月行一期经椎间孔入路病灶切除椎间植骨融合内固定术治疗的腰椎结核患者90例,随机分为小剂量氨甲环酸治疗组(小剂量组)、大剂量氨甲环酸治疗组(大剂量组)和对照组,每组30例。所有患者全身抗结核治疗2~3周后行一期经椎间孔入路病灶切除椎间植骨融合内固定治疗。小剂量组静脉泵注含1 mg/kg氨甲环酸的生理盐水50 mL,大剂量组泵注含15 mg/kg氨甲环酸的生理盐水50 mL,对照组泵注等量生理盐水,均于术前30 min开始泵注。记录手术时间,术中和术后出血时间、出血量、输血量,手术前后凝血功能,术后引流量、血红蛋白量及红细胞比容,住院时间、术后恢复时间及其他不良事件。结果3组患者手术时间、术中及术后出血时间、术后出血量及输血量、手术前后凝血功能、住院时间、术后恢复时间差异均无统计学意义(P>0.05)。大剂量组术中出血量及输血量和术后引流量均较小剂量组和对照组降低,差异有统计学意义(P<0.05),小剂量组与对照组差异无统计学意义(P>0.05)。大剂量组术后血红蛋白水平、术后红细胞比容均高于小剂量组及对照组,差异有统计学意义(P<0.05),小剂量组与对照组之间差异无统计学意义(P>0.05)。所有患者围手术期均未发生手术部位感染、血管和神经损伤及静脉血栓等严重并发症。所有患者术后随访8~12个月,椎间植骨均获得骨性融合,未发生假关节形成,内固定物断裂、松动、脱落等情况。所有患者结核症状消失,病灶全部愈合,无复发。结论术前预防性应用大剂量氨甲环酸可降低脊柱结核患者围手术期出血风险,且不增加不良事件发生风险。     

口服和静脉注射氨甲环酸对于腰椎椎管减压融合术的围手术期失血量影响

目的 ：探讨氨甲环酸（tranexamic acid,TXA）不同给药方式对腰椎椎管减压融合术围手术期失血量、隐性出血量、输血率,以及不良反应等各方面的影响。方法：对2019年7月至2020年7月接受腰椎椎管减压融合术的60例患者进行回顾性分析,根据TXA不同给药方式分为观察组和对照组,每组30例。观察组术前2 h口服2 g TXA;对照组在切皮前5～10 min予以1 g TXA静脉输注,术后6 h予以1 g TXA静脉输注1次。分别记录两组患者术中出血量、术后引流量、总失血量、隐性失血量、引流管拔除时间、输血率、静脉血栓形成率、不良事件发生率,观察术前和术后1、3 d血红蛋白（hemoglobin,Hb）,红细胞比容（hematocrit,HCT）的变化情况。结果：术后1、3 d的Hb及HCT均较术前有明显改善（P<0.01）,但组间比较差异无统计学意义（P>0.05）。两组术中出血量、术后引流量、总失血量、术中失血量、隐性失血量、拔管时间、输血率比较差异无统计学意义（P>0.05）。两组患者均未见静脉血栓形成和不良事件发生。结论：在腰椎椎管减压融合术围手术期口服...     

氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术失血量的影响

目的探讨氨甲环酸局部应用并不放置引流对高龄人工股骨头置换术患者失血量的影响。 方法回顾性收集济宁医学院附属医院骨关节科收治的50例因股骨颈骨折行人工股骨头置换术的高龄患者,随机分为试验组和对照组,每组各25例。试验组在缝合阔筋膜张肌后关节腔注射2 g氨甲环酸,并加入生理盐水稀释至50 ml;对照组则关节腔注射50 ml生理盐水,2组术后均不放置引流。比较两组患者术中显性失血量、术后隐性失血量、总失血量、输血率、术后第1、3、5天血红蛋白以及下肢深静脉血栓、肺栓塞、切口感染等并发症的发生率。 结果试验组第1、3、5天血红蛋白浓度高于对照组（t=7.473, t=7.226, t=7.572, P<0.05）,其总失血量、显性失血量、隐性失血量及输血率低于对照组,差异有统计学意义（t=7.881, t=15.353, t=7.225, t=5.781,P<0.05）。两组患者术中出血量差异比较无统计学意义（t=1.382,P>0.05）。两组患者均无下肢深静脉血栓形成及肺栓塞发生。两组患者均有1例发生下肢肌间静脉血栓,无统计学差异。两组患者术后3 h相关凝血指标比较差异无统计学意义（t=1.483, t=1.352, t=1.466,P>0.05）。 结论人工股骨头置换术中关节腔注射氨甲环酸并不放置引流,能有效减少术后失血和输血,不增加下肢深静脉血栓形成和肺栓塞的发生,对凝血无影响。     

The Effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study.

STUDY DESIGN: A prospective study evaluating the efficacy of epsilon-aminocaproic acid (EACA) in decreasing perioperative blood loss in idiopathic scoliosis. OBJECTIVES: To compare the perioperative blood loss and need for blood replacement in two groups of patients undergoing surgery for idiopathic scoliosis. One group received intraoperative EACA; the other did not and served as controls. SUMMARY OF BACKGROUND DATA: Excessive blood loss increases the operative time, risk for blood product disease transmission, postoperative complications, and costs associated with posterior spinal fusion and instrumentation. EACA is an antifibrinolytic agent that has been shown to be effective in reducing perioperative blood loss during pediatric cardiothoracic surgical procedures. We hypothesized that it would also be effective in lowering blood loss during posterior spinal fusion for idiopathic scoliosis. METHODS: We compared the perioperative blood loss of 28 consecutive pediatric patients with idiopathic scoliosis who underwent posterior spinal fusion and received intraoperative EACA with 31 consecutive patients who did not receive this medication and served as a control group. RESULTS: The patients in both groups were similar. Patients in the EACA group demonstrated statistically significant decreases in total estimated perioperative blood loss and the need for autologous blood transfusion. The patients in the EACA group had no intraoperative or postoperative complications related to the use of this medication. CONCLUSIONS: Based on these preliminary findings, we believe that EACA is helpful in decreasing blood loss in patients undergoing posterior spinal fusion and instrumentation, and may decrease the number of autologous units needed to maintain safe perioperative hemoglobin levels, thereby improving safety and lowering cost associated with scoliosis surgery.     

The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: a single-surgeon experience

Purpose

Intraoperative blood loss in scoliosis surgery often requires transfusions. Autogenous blood decreases but does not eliminate risks typically associated with allogenic blood transfusion. Costs associated with transfusions are significant. Tranexamic acid (TXA) has been shown to decrease blood loss in cardiac and joint surgery. Few studies have examined its use in pediatric spine surgery, and the results are inconsistent. The aim of this study was to determine whether TXA decreases intraoperative blood loss and transfusion requirements in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by a single surgeon.

Methods

The medical records and operative reports of surgically treated patients with adolescent idiopathic scoliosis between 2000 and 2009 were retrospectively reviewed. The inclusion criteria were: (1) patients who underwent instrumented posterior spinal fusion, (2) had complete medical records, and (3) were treated by the same surgeon. Forty-nine patients who met the inclusion criteria were divided into two groups: Group A (25 patients) received TXA, while Group B (24 patients) did not receive TXA.

Results

After controlling for age at the time of surgery, gender, and number of vertebral levels fused, the mean intraoperative blood loss was significantly lower in Group A (537 ml) than in Group B (1,245 ml) (p = 0.027). The mean volume of blood transfused intraoperatively was 426 and 740 ml for Group A and Group B, respectively. The difference was not statistically significant after controlling for age, gender, and number of levels fused (p = 0.078).

Conclusion

TXA significantly decreased intraoperative blood loss in posterior spinal fusions performed for adolescent idiopathic scoliosis.     

Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds — A double blind randomised controlled trial

IntroductionThis study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns.MethodsThis was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15?55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH).ResultsThirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm²; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups.ConclusionTXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion.     

Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid

IntroductionCraniosysnostosis surgical corrections are routine procedures in the pediatric neurosurgical field. However, these procedures result in significant blood loss. Tranexamic acid (TXA) is an antifibrinolytic drug, which has demonstrated a significant reduction in perioperative blood loss in many pediatric surgical procedures such as cardiac surgery and scoliosis surgery. We conducted a systematic review to evaluate protocols of TXA use in pediatric craniosynostosis procedures and its effect on intraoperative blood loss and transfusions.Material and methodsA comprehensive literature review of the National Library of Medicine (PubMed) database was performed to identify relevant studies. We included any clinical study reporting on blood loss or blood transfusion for pediatric craniosynostosis surgery with intraoperative use of tranexamic acid, with the following limits: publication date from inception to May 2019; reports in English.ResultsThirteen studies were eligible for our review. Of the 13 studies, 4 were prospective, randomised, double-blind controlled trials, 9 were retrospective studies, tailored as a “before–after” studies, comparing blood loss and transfusion without/with TXA. TXA significantly decreases the number and volume of packed red blood cell transfusions and the rate of transfusion in children undergoing craniosynostosis surgery. Significantly fewer fresh frozen plasma transfusions were required in the TXA groups in 2 randomised studies. Length of stay in hospital was significantly lower with the use of TXA in three studies. Advantages of TXA administration also include an excellent patient tolerance of side effects, ease of administration and low cost.ConclusionTXA significantly reduces blood loss and the need for transfusions in children undergoing craniosynostosis surgery. TXA administration should be a routine part of strategy to reduce blood loss and limit transfusions in these procedures.     

Thoracoscopic anterior spinal release and fusion: evolution of a faster,improved approach

Purpose: The aim of this study was to compare the perioperative parameters and outcomes of video-assisted thoracoscopic surgery (VATS) with open thoracotomy for anterior release and fusion in the treatment of pediatric spinal deformities. Methods: Twenty-six patients treated with VATS anterior spinal release and posterior spinal fusion by the authors were reviewed retrospectively. Fourteen age- and disease-matched patients who underwent open thoracotomy for anterior spinal release and posterior spinal fusion by the same group of surgeons during the same time period were evaluated for comparison. Patients whose anterior level of exposure extended below the diaphragm were excluded. Results: Blood loss, operative transfusion, and length of postoperative chest tube use all were decreased in the VATS patients compared with thoracotomy patients (P [le ] .05). The average operating time for VATS was less than that for thoracotomy but did not reach statistical significance. However, operating time was significantly shorter in the second 13 VATS patients compared with the first 13 patients. No complications specifically related to the VATS approach were identified. Conclusions: The VATS technique is a safe and comparable alternative to open thoracotomy. Although there is a learning curve for VATS, greater experience could show an advantage in this approach to the anterior spine for the treatment of pediatric spinal deformity.     

氨甲环酸对全髋关节置换术的止血及安全分析

目的探讨氨甲环酸(TXA)对初次单侧全髋关节置换术(THA)围手术期的输血率及术后并发症的影响。 方法回顾性分析2010年1月至2018年12月在中山大学附属第一医院关节外科行过初次单侧THA患者的病历资料。纳入标准：行初次单侧非骨水泥THA患者;术前凝血正常;髋关节疾病类型为髋关节骨关节炎、股骨头缺血性或无菌性坏死、发育性髋关节发育不良、股骨颈骨折、类风湿性关节炎以及强直性脊柱炎;术前切皮前按体重15 mg/kg给予TXA。排除标准：行髋关节翻修患者,同时有合并除单侧THA其他手术患者;凝血功能异常;合并恶性肿瘤;既往有心肌梗死或下肢血栓史;使用骨水泥假体;其他髋关节疾病类型;术前切皮前不是按体重15 mg/kg给予TXA等。根据术后使用抗凝药与未使用抗凝药两种情况,初次单侧THA术后使用抗凝药的患者,使用TXA实验组共556例,未使用TXA对照组共244例;初次单侧THA术后未使用抗凝药的患者,使用TXA实验组共248例,未使用TXA对照组共130例。本研究采用独立样本t检验、Wilcoxon秩和检验及卡方检验统计学方法,比较两种情况下两组输血率、输悬浮红细胞(RBC)量、血红蛋白(HB)最大丢失量、并发症及术后住院时间等。 结果对于行初次单侧THA患者,在术后使用抗凝药物情况下,实验组输血率14.4%,对照组48.4%,差异有统计学意义(χ²＝105.085,P<0.001);实验组中输悬浮RBC量低于对照组(2.0 U vs 2.5 U,Z＝-2.600,P<0.01)(1 U＝200 ml);实验组HB最大丢失量低于对照组(32.0 g/L vs 36.3 g/L,Z＝-4.402,P<0.001)。实验组伤口周围瘀斑(0例)低于对照组(5例)(P<0.05);伤口其他并发症及发生血栓事件差异无统计学意义(P>0.05);实验组与对照组术后住院时间差异无统计学意义(P>0.05)。在术后未使用抗凝药情况下,实验组输血率低于对照组(9.7% vs 53.8%,χ²＝89.058,P<0.001),实验组输入悬浮RBC量与对照组差异无统计学意义(3.5 U vs 4.0 U,Z ＝-0.303,P>0.05),实验组HB最大丢失量低于对照组(29.8 g/L vs 39.5 g/L,Z ＝-6.285,P<0.001)。实验组出现伤口感染低于对照组(1例vs 5例,P<0.05);伤口其他并发症及血栓事件差异无统计学意义(P>0.05);实验组术后住院时间低于对照组(7.0 d vs 8.0 d,Z＝-6.165,P<0.001)。 结论TXA对行初次单侧THA患者,在使用抗凝药与未使用抗凝药两种情况下,均能降低输血率、HB最大丢失量,具有明显的止血效果,且不增加术后伤口及发生血栓并发症,具有一定的安全性。     

Factors influencing early survival after liver transplantation

The purpose of this study was to analyze data from all adult and pediatric liver transplants performed between January 1, 1983 and January 15, 1986 at the University of Minnesota Hospital and identify perioperative variables that predict patient survival and could aid in patient selection. Charts, intraoperative anesthesia records, blood bank records, flow sheets, outpatient records, and autopsy reports were examined in 45 pediatric and 15 adult patients who underwent primary orthotopic liver transplantation. Analysis of the data can be summarized as follows: (1) Pediatric patients whose coagulation parameters could not be corrected prior to operation and who consequently required preoperative exchange transfusion had poorer outcomes than those not requiring an exchange to correct coagulation parameters. (2) The rapid infusion technique for massive blood transfusion resulted in significantly decreased blood loss and intraoperative blood product replacement. (3) Twenty-four hour postoperative factor V levels were good predictors of survival. Patients with poor factor V levels required rigorous replacement of coagulation factors. (4) Pediatric patients with uncorrectable coagulopathies requiring immediate postoperative exchange transfusion had extremely high mortality.     

Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid

IntroductionTranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents.MethodThis retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented.ResultsEpidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P < 0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred.ConclusionThe efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications.     

Tranexamic acid given intraoperatively reduces blood loss after total knee replacement: a randomized,controlled study

BACKGROUND: Extensive blood loss in total knee replacement (TKR) surgery is well known and is associated with a high transfusion rate of allogenic blood. Tranexamic acid (TXA) has been shown to reduce blood loss by 50% in this patient group, but only in cases with a perioperative loss of 1400-1800 ml. This study was performed to see if TXA offers any advantages in knee replacement surgery with blood loss at 800 ml. METHODS: Thirty consecutive patients scheduled for TKR in spinal anesthesia with the use of a tourniquet, were randomized to TXA or non-TXA. Tranexamic acid 10 mg kg-1 was given at conclusion of surgery and again 3 h later. Blood loss was registered. RESULTS: Total blood loss was at all times significantly lower in the TXA group compared to the non-TXA group (409.7+/-174.9 ml vs. 761.7+/-313.1 ml; P<0.001). There were no differences in coagulation parameters. No patients in the TXA group had a blood transfusion vs. 13% in the non-TXA group (NS). No complications were registered in the two groups. CONCLUSION: We conclude that TXA significantly reduces blood loss after total knee replacement surgery.     

Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Total knee arthroplasty (TKA) is a common procedure, and bilateral TKA ensures cost efficiency. Bilateral TKA is associated with increased requirement of blood transfusion (BT). BT is associated with hazards, therefore be avoided. Tranexamic acid (TXA) has been suggested to reduce the BT, and the use of TXA in bilateral TKA appears sparse in literature. This study aimed at assessing the effect of TXA in such patients. This prospective randomized controlled trial evaluated the use of TXA in bilateral TKA. Pre- and postoperative hemoglobin (Hb) and packed cell volume (PCV), blood loss and BT, hospital stay, and the cost of TXA compared to blood transfusion were the measured variables. 175 patients (n?=?88 TXA, n?=?87 CTRL) completed the study. The patients in the control (CTRL) group on an average received 0.3 units and 0.07 in TXA group. The average blood loss in the TXA group was significantly less than the CTRL (P?<?0.0001). There was no significant difference in the perioperative complications, hospital stay in the two groups. The use of TXA reduces the postoperative blood loss. The allogenic BT requirement in patients undergoing bilateral TKA is significantly decreased. The routine use of this drug is cost-effective and reduces postoperative blood loss.     

Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: A randomized controlled trial

BackgroundIntravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture.MethodsBetween January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups.ResultsThe mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls.ConclusionsThe results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.     

氨甲环酸不同静脉给药方式对青少年特发性脊柱侧凸后路矫形术中出血量的影响

目的 对比氨甲环酸(TXA)不同静脉给药方式对青少年特发性脊柱侧凸(AIS)后路矫形术中出血量的影响及安全性.方法 2017年1月—2020年3月,廊坊市第四人民医院采用脊柱后路矫形术治疗AIS患者120例,按照随机数字表法分为3组,每组40例.A组切开皮肤前15 min静脉滴注TXA 30 mg/kg;B组切开皮肤前15 min静脉滴注TXA 15 mg/kg,术中给予TXA 10 mg/(kg·h)维持至术毕;C组围手术期不使用TXA.比较3组手术时间、术中出血量、异体血输注量、晶体输注量、胶体输注量、术后输血率、术后引流量及手术前后血红蛋白(Hb)水平、D-二聚体(D-D)水平等指标,并记录并发症发生情况.结果 所有手术顺利完成.A、B组术中出血量、异体血输注量、胶体输注量、术后输血率、术后1 d引流量低于C组,术后各时间点Hb水平高于C组,差异均有统计学意义(P<0.05);以上指标A、B组组间比较,差异无统计学意义(P>0.05).3组术后各时间点D-D水平均较术前明显升高,术后1 d达到最高值,之后逐渐下降;术后各时间点A、B组D-D水平低于C组,差异均有统计学意义(P<0.05);A、B组组间比较,差异无统计学意义(P>0.05).所有患者切口愈合良好,术后双下肢血管超声检查未见深静脉血栓形成.术后电话随访均未出现相关并发症.结论 术前TXA足够剂量静脉滴注可取得与首次负荷量联合术中维持量静脉滴注相同的止血效果,无安全隐患,术前单剂量静脉滴注在操作上更为简便,值得推广应用.     

Removal of aprotinin from low-dose aprotinin/tranexamic acid antifibrinolytic therapy increases transfusion requirements in cardiothoracic surgery

This retrospective study investigated whether withdrawal of aprotinin from combined low-dose aprotinin/tranexamic acid (TXA) antifibrinolytic therapy altered postoperative blood loss and transfusion requirements in patients undergoing cardiothoracic surgery employing cardiopulmonary bypass (CPB). The study included data from patients receiving a combination of low-dose aprotinin (2×10(6)?KIU in CPB prime; n=615) and 2000?mg TXA or patients receiving TXA only (n=587). In both groups, TXA was given after protamine administration. Study endpoints were blood loss, transfusion requirements and reoperation. There were no differences in EuroSCORE, CPB time, antiangial medication and baseline coagulation parameters between groups. There were more males in the TXA group (85%) as compared to the TXA+aprotinin group (77%; P=0.02). Postoperative blood loss (0.80±0.69 vs. 0.66±0.52?l; P=0.001) and transfusion of fresh frozen plasma (0.6±0.7 vs. 0.4±0.6?U; P<0.001), packed cells (3.9±5.5 vs. 2.7±3.3?U; P<0.001) and platelets (0.7±0.6 vs. 0.5±0.6?U; P<0.001) was higher in the TXA group than in patients receiving combined therapy, respectively. There were more reoperations for bleeding in the TXA group (53 vs. 34, respectively; P=0.03) with similar mortality and deterioration in glomerular filtration rate. In conclusion, withdrawal of aprotinin from combined antifibrinolytic therapy is associated with increased blood loss, transfusion requirements and reoperations.     

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。     

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。     

The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

BACKGROUND CONTEXTTranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction.PURPOSEThe primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects.STUDY DESIGNProspective, double-blinded, randomized controlled trial.PATIENT SAMPLEA total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study.OUTCOME MEASURESThe primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL.METHODSPatients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo.RESULTSThe mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1–786.1 mL, p<0.001; 515.6 mL, 95% CI, 267.6–763.6 mL, p<.001]; (36.11%, p=.029, p=.013). Meanwhile, the mean TBL, maximum Hb decrease, and volume of drainage were also significantly lower in group A and B than in group C. IL-6 and CRP in group A and B were significantly lower than in group C from postoperative days 1 to 3. All these differences were not significant between groups A and B. No drug-related complications were observed in any patient. Multiple regression showed that the application of postoperative TXA and number of screws were significant parameters affecting PBL.CONCLUSIONSA multiple-dose regimen of TXA, either by oral or intravenous application, could be a safe and effective means of controlling PBL and decreasing the postoperative transfusion rate in patients with AIS who underwent scoliosis surgery. In addition, it could inhibit postoperative inflammatory response.     

The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery.

STUDY DESIGN: Controlled study to assess the efficacy of aprotinin and Amicar in reducing blood loss during complex spinal fusions. OBJECTIVES: To compare blood loss and the clotting profile with a thromboelastogram in patients with spinal deformities undergoing sequential anterior and posterior spinal fusions treated intraoperatively with either aprotinin or Amicar. SUMMARY OF BACKGROUND DATA: Spinal fusion for correction of adult spinal deformities is associated with large blood losses despite the implementation of multiple factors to reduce this blood loss. The antifibrinolytics aprotinin and Amicar have both been shown to reduce blood loss in other surgical procedures with the potential for large blood loss. Hence, we compared their efficacy for reducing blood loss in complex spinal fusions. METHODS: Sixty patients for elective sequential anteroposterior thoracolumbosacral fusions were randomly assigned to three groups: control, aprotinin, and Amicar. Patients were assessed for blood loss, transfusion requirements, postoperative complications, and coagulation profile using a thromboelastogram. RESULTS: The study demonstrated a significant reduction in total blood loss (aprotinin 3628 mL, Amicar 4056 mL, control 5181 mL) and transfusion requirements using the half-dose aprotinin regimen compared with Amicar or control. Aprotinin also preserved the thromboelastogram mean clot formation time, clot strength, and clotting index compared with Amicar or control. CONCLUSIONS: For complex spinal operations with large blood losses, the half-dose aprotinin regimen will reduce blood loss and the need for blood components and may have a role in reducing postoperative lung injury.