氨甲环酸不同用药途径对女性股骨颈骨折全髋关节置换术失血的疗效分析

目的：研究氨甲环酸不同应用方式治疗老年女性股骨颈骨折行全髋关节置换术围手术期失血的疗效。方法：将2015年12月至2018年1月老年女性股骨颈骨折行全髋关节置换术患者77例分成4组：A组（静脉用药组）21例,年龄（77.10±7.02）岁,于手术切皮前5 min使用15 mg/kg氨甲环酸静脉滴注并且术中生理盐水灌注关节腔;B组（局部用药组）18例,年龄（73.83±6.56）岁,于手术切皮前5 min生理盐水静脉滴注并且术中使用总剂量为3 g的氨甲环酸灌注关节腔;C组（联合用药组）19例,年龄（74.26±6.04）岁,术前使用15 mg/kg氨甲环酸静滴并且术中使用总剂量为1.5 g的氨甲环酸灌注关节腔;D组（对照研究组）19例,年龄（76.69±9.27）岁,于手术切皮前5 min生理盐水静脉滴注并且术中生理盐水灌注关节腔。记录术后伤口引流量、血红蛋白变化,根据身高体重和手术前后的红细胞压积（HCT）计算所有患者的总失血量等。结果：A组术后引流量为（111.91±35.02） ml,血红蛋白改变量为（26.86±12.99） g/L,总失血量为（628.6±306.78） ml;B组术后引流量为（108.89±36.61） ml,血红蛋白改变量为（26.28±8.59） g/L,总失血量为（584.41±250.86） ml;C组术后引流量为（102.63±47.36） ml,血红蛋白改变量为（26.89±12.47） g/L,总失血量为（634.78±384.89） ml;D组术后引流量为（107.37±40.53） ml,血红蛋白改变量为（40.95±12.48） g/L,总失血量为（1 005.24±483.37） ml。4组术后引流量比较差异无统计学意义（P>0.05）;A、B、C组术后血红蛋白改变量、总失血量少于对照组D组（P<0.05）,但是3组组间比较差异无统计学意义（P>0.05）。结论：应用氨甲环酸能有效减少老年女性股骨颈骨折行全髋关节置换术围手术期失血,但是最佳给药方式及给药剂量需要进一步的研究。     

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...     

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.     

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.     

Oral vs Intravenous vs Topical Tranexamic Acid in Primary Hip Arthroplasty: A Prospective,Randomized, Double-Blind,Controlled Study

Background

Tranexamic acid (TXA) has demonstrated efficacy in reducing blood loss, reduction in hemoglobin, and blood transfusion requirements in primary total hip arthroplasty (THA). The optimal mode of TXA administration for patients undergoing primary THA is unclear. The purpose of this randomized controlled trial is to determine whether oral administration of TXA was superior to intravenous or topical routes in these patients.

Use of Topical Tranexamic Acid Reduces Direct and Indirect Blood Loss and Transfusion Rates in Revision Total Hip Arthroplasty

Background

In primary total hip arthroplasty (THA), evidence supports the use of tranexamic acid (TXA) as an effective strategy for reducing blood loss, but scant evidence supports its use in revision THA.

Questions/Purposes

We aimed to evaluate whether the use of topical TXA in revision THA is associated with less blood loss and lower transfusion rates and to assess its safety, specifically as it relates to thromboembolic complications.

Methods

In this retrospective comparative study, two groups who underwent revision THA between 2005 and 2017 were defined: 98 patients who received 3 g of topical TXA (study group) and 475 patients who did not receive TXA (control group). Subjects were divided into subgroups according to the type of revision. Hemoglobin and hematocrit levels, blood loss, and transfusions were recorded. The follow-up period was 6 weeks.

Results

Median estimated blood loss, hidden blood loss, hemoglobin drop, and transfusion rates were significantly lower in the study group. The rates of post-operative thromboembolism were similar in the two groups. According to subgroup analysis, patients with revision of the femoral component, both components, and staged exchange revisions showed significantly lower rates of transfusion.

Conclusion

Topical TXA administration during revision THA effectively reduced direct and indirect blood loss, including hidden losses, without increasing the rates of thromboembolic events. This effect appeared to be enhanced when the femoral component was revised.

     

Combination effect of intraoperative and postoperative intravenous tranexamic acid in hip hemiarthroplasty. A propensity score matched analysis

BackgroundTranexamic acid (TXA) has been proven to reduce perioperative blood loss and the incidence of allogeneic blood transfusion in total joint arthroplasty (TJA). However, there is limited literature on the use of TXA in patients undergoing hip hemiarthroplasty. Furthermore, combination effect of intraoperative and postoperative intravenous TXA has not been investigated extensively. The purpose of this study was to evaluate this combination effect on hip hemiarthroplasty by a propensity score matched analysis (PSMA).MethodsThis is a retrospective cohort study involving hip hemiarthroplasty for femoral neck fracture. All patients received 1g intraoperative intravenous TXA. One group also received 1g intravenous TXA 6h after surgery, while the other group did not. Perioperative blood loss, the incidence of allogeneic blood transfusion and venous thromboembolism (VTE) were collected and compared.Results209 patients who underwent unilateral hip hemiarthroplasty were included. PSMA resulted in 66 matched pairs in each group. There were no significant differences in perioperative blood loss on postoperative day (POD) # 1, 3, 5 (637.2 ± 285.9 versus 653.6 ± 305.5, 726.6 ± 274.2 versus 676.3 ± 313.2, 795.5 ± 291.2 versus 759.9 ± 328.4), the incidence of allogeneic blood transfusion (9.1% versus 12.1%) and VTE (1.5% versus 1.5%) between the two groups (P value> 05) for up to one year.ConclusionIntraoperative and postoperative intravenous TXA have no combination effect on reducing perioperative blood loss, the incidence of allogeneic blood transfusion and VTE in patients undergoing hip hemiarthroplasty.     

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。     

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.     

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.     

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.     

Blood-Sparing Efficacy of Oral Tranexamic Acid in Primary Total Hip Arthroplasty

Background

Tranexamic acid (TXA) has been shown to be effective in reducing blood loss, hemoglobin drop, and blood transfusion in primary total hip arthroplasty. Most studies used intravenous form or topical form. This study was to assess the blood-sparing efficacy and safety of oral TXA in total hip arthroplasty.

Tranexamic Acid Is Associated With Reduced Periprosthetic Joint Infection After Primary Total Joint Arthroplasty

BackgroundPrevious studies have demonstrated preoperative anemia to be a strong risk factor for periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). Allogeneic blood transfusion can be associated with increased risk of PJI after primary and revision TJA. Tranexamic acid (TXA) is known to reduce blood loss and the need for allogeneic blood transfusion after TJA. The hypothesis of this study is that administration of intravenous TXA would result in a reduction in PJI after TJA.MethodsAn institutional database was utilized to identify 6340 patients undergoing primary TJA between January 1, 2013 and June 31, 2017 with a minimum of 1-year follow-up. Patients were divided into 2 groups based on whether they received intravenous TXA prior to TJA or not. Patients who developed PJI were identified. All PJI patients met the 2018 International Consensus Meeting definition for PJI. A multivariate regression analysis was performed to identify variables independently associated with PJI.ResultsOf the patients included, 3683 (58.1%) received TXA and 2657 (41.9%) did not. The overall incidence of preoperative anemia was 16%, postoperative blood transfusion 1.8%, and PJI 2.4%. Bivariate analysis showed that patients who received TXA were significantly at lower odds of infection. After adjusting for all confounding variables, multivariate regression analysis showed that TXA is associated with reduced PJI after primary TJA.ConclusionTXA can help reduce the rate of PJI after primary TJA. This protective effect is likely interlinked to reduction in blood loss, lower need for allogeneic blood transfusion, and issues related to immunomodulation associated with blood transfusion.     

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。     

Tranexamic acid is effective in lower doses with infusion in total knee arthroplasty

ObjectiveTo identify the most effective intravenous regimen with reduced doses of tranexamic acid (TXA).MethodsWe retrospectively evaluated the two most frequently used TXA regimens (infusion and divided-dose regimens) in total knee arthroplasty in comparison with patients not treated with TXA, in three groups. Group NO (n = 134; 19 men and 115 women; mean age: 66.48 ± 7.66) (patients who were not treated with TXA); group DIV (n = 158; 14 men and 144 women; mean age: 65.67 ± 7.98) (total dose of 10 mg/kg intravenous TXA divided into two doses: 15 minutes before tourniquet inflation and 15 minutes before tourniquet deflation), an extra 5 mg/kg intravenous TXA dose was administered 2 hours after surgery in the orthopedic ward, if needed; and group INF (n = 193; 33 men and 160 women; mean age: 67.08 ± 7.2) (10 mg/kg TXA perioperative intravenous infusion starting 15 minutes before surgery until closure of the wound, and 5 mg/kg additional intravenous dose was administered 12 hours after surgery). Pre-postoperative hemoglobin (Hb) and hematocrit (Htc) difference, total blood loss (TBL), number of transfused packed red blood cells (pRBC), and length of hospital stays (LOS) were compared between the groups.ResultsTBL was lower in group INF (531.61 ± 316.76 mL) in comparison with group DIV (999.91 ± 352.62 mL). TBL was statistically significantly higher in Group NO (1139.23 ± 43 mL). The mean number of transfused pRBC was significantly higher in the control group (1.22 ± 0.58 units) than the in the other TXA groups. The mean number of transfused pRBC was significantly lower in INF group (0.33 ± 0.56 units) than DIV group (0.75 ± 0.63 units). The number of patients requiring transfusion was significantly lower in INF group (28.5%) than DIV group (65.2%). Group NO had the highest number of patients requiring transfusion (96.3%). Pre-postoperative Hb and Htc difference was significantly lower in INF group (?1.19 ± 0.9 gr/dL and ?3.74 ± 2.96%). The mean LOS of the control group, group DIV and group INF were 7.16 ± 2.29, 6.93 ± 2.39 and 5.06 ± 1.24 days, respectively. Group INF had the lowest hospital stay time in comparison with the other groups (p < 0.005). There was no statistically significant difference between the control group and group DIV in the LOS.ConclusionA total dose of 10 mg/kg of TXA perioperative intravenous infusion starting 15 minutes before the surgery until wound closure can significantly decrease TBL. Intraoperative infusion regimen is more effective than the divided-dose regimen.Level of EvidenceLevel III, Therapeutic Study.     

The effect of tranexamic acid on hidden bleeding in older intertrochanteric fracture patients treated with PFNA

ObjectiveTo investigate the effect of tranexamic acid (TXA) on hidden bleeding in older intertrochanteric fracture patients treated with intramedullary nails.MethodBetween January 2016 and January 2017, 100 cases of intertrochanteric fractures eligible for the study were treated with proximal femoral nail antirotation (PFNA) in our hospital. All patients were divided into two groups of 50 patients each: the TXA group and a blank control group. In the TXA group, all patients received TXA at a dose of 10 mg/kg⁻¹ intravenously, 10 min preoperatively and 5 h postoperatively. The control group did not receive TXA. We recorded the volume of intraoperative blood loss and postoperative drainage, and the need for postoperative blood transfusion and transfusion volume for all patients. Blood routine examination was performed on the day of surgery and 2 days postoperatively. We calculated the total blood loss and hidden blood loss in the two groups separately according to the Gross equation. All patients underwent deep vein ultrasound of the lower limbs preoperatively and 1 week postoperatively to detect thrombosis.ResultsCompared with controls, patients in the TXA group had lower: overt bleeding (50.59 ml; p = .012), total blood loss (181.58 ml; p = .005), hidden blood loss (130.64 ml; p = .037), volume of blood transfusion (110.0 ml; p = .019), and 20% lower transfusion rate compared with the control group. Patients receiving short-nail fixation had significantly lower hidden blood loss compared with patients receiving long-nail fixation (p < .05). However, we found no statistically significant difference in the incidence of deep vein thrombosis in the lower limbs between the two groups (p = .938).ConclusionTXA significantly reduced hidden blood loss in older intertrochanteric fracture patients treated with intramedullary nails without an increased risk of thrombosis in lower limb deep veins.     

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。     

Topical administration of tranexamic acid in elderly patients undergoing short femoral nailing for intertrochanteric fracture: A randomised controlled trial

IntroductionTopical application of tranexamic acid (TXA) has been proposed as an alternative to intravenous administration to reduce perioperative bleeding in orthopaedic surgery. The purpose of this randomised controlled trial was to evaluate the efficacy and safety of 1 g topically applied TXA in patients undergoing fixation of intertrochanteric hip fractures by short femoral nailing.MethodsA total of 121 patients were enrolled between May 2018 and January 2020. Patients were randomly allocated (1:1) to receive either 10 mL (1 g) of TXA or 10 mL of normal saline (NS) injected through the subfascial drain following wound closure. Total blood loss, total drain output and blood transfusion requirements up to postoperative day 3 were recorded. Rates of thromboembolic complications and mortality up to 90 days postoperatively were also compared.ResultsThere was no statistically significant difference in total blood loss, total drain output or proportion of patients requiring transfusions. Median total blood loss was 1.088 L (IQR: 0.760–1.795) in the TXA group and 1.078 L (IQR: 0.797–1.722) in the NS group (P = .703). Median total drain output was 60 mL (IQR: 40–140) in the TXA group and 70 mL (IQR: 30–168) in the NS group (P = .696). Blood transfusions were administered in 29 patients (47.5%) in the TXA group and 27 patients (45.0%) in the NS group (P = .782). There was also no difference in frequency of thrombotic complications or mortality within 90 days. There were five thrombotic events in the TXA group and four in the NS group (P = .751). The 90-day mortality rate was 6.6% (4 patients) in the TXA group and 3.3% (2 patients) in the NS group (P = .680).ConclusionA 1 g dose of topically administered TXA did not produce any difference in blood loss, transfusion requirements, thromboembolic complications, or 90-day mortality. Future trials may consider the effect of larger doses in patients undergoing hip fracture fixation surgery.     

氨甲环酸不同给药方式对RA患者行全膝关节置换术围术期失血量的影响

目的探讨氨甲环酸不同给药方式对类风湿性关节炎(RA)患者行全膝关节置换术(TKA)围术期失血量的影响。方法收集自2012-03—2015-04在本院初次行TKA治疗的106例RA患者,随机分为静脉给药组、关节注射组和联合组,静脉给药组于止血带充气前15 min静滴氨甲环酸(TXA)1g,关节注射组术毕缝合关节囊后经关节囊切口注射TXA 1g,联合组于止血带充气前15 min静滴TXA 1g,术毕缝合关节囊后经关节囊切口注射TXA 1g。结果联合组术后24、72 h Hb、Hct均高于静脉给药组和关节注射组,引流量、隐性失血量和总失血量均低于静脉给药组和关节注射组,差异有统计学意义(P0.05);3组术前和术后Fib、PT和APTT比较差异无统计学意义(P0.05);静脉给药组和联合组均无输血者,3组均未发现DVT和肺栓塞。结论 RA患者TKA术前静脉滴注TXA联合经关节囊局部用药可减少围术期失血量,且不会增加DVT和肺栓塞发生风险。     

Oral and intravenous tranexamic acid are equivalent at reducing blood loss following shoulder arthroplasty—A multicenter,double-blinded,randomized, placebo-controlled trial

BackgroundTranexamic acid (TXA) has been shown to reduce blood loss significantly in shoulder arthroplasty. Oral TXA is significantly cheaper than intravenous TXA, but there has been no published literature comparing oral and intravenous TXA in shoulder arthroplasty. The purpose of this study was to compare the efficacy and safety of oral versus intravenous TXA in shoulder arthroplasty. We hypothesized that oral and intravenous TXA are equivalent at reducing blood loss following shoulder arthroplasty.MethodsThis study was approved by the New Zealand Health and Disability Ethics Committee (HDEC) and registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR). Patients undergoing elective shoulder arthroplasties were prospectively randomized into one of two groups. In the oral TXA group, 2g of TXA was administered two hours prior to induction of anesthesia, and in the intravenous TXA group, 1.5g of TXA was administered as a bolus following induction of anesthesia. The primary outcome was a reduction in hemoglobin concentration. The secondary outcomes included drain output, number of blood units transfused, length of hospital stay, and complications.ResultsA total of 80 consecutive patients were randomized. The baseline demographics were comparable between the two groups. There was no difference in the primary outcome measure or any of the secondary outcome measures. With regards to the primary outcome measure, using a two one-sided test (TOST) for equivalence, with a P value of < 0.05 demonstrating equivalence, the mean reduction of hemoglobin was 23.30g/L (± 1.62) versus 22.45g/L (± 1.30) for the oral and the intravenous groups, respectively (P < .001). Postoperative drain output was 74.58mLs (± 11.27) versus 90.03mLs (± 14.53) for the oral and the intravenous groups, respectively (P = .41). Furthermore, there was no difference in the number of blood units transfused, length of hospital stay, and complications.DiscussionTo the best of our knowledge, this is the first study in the literature comparing oral and intravenous tranexamic in shoulder arthroplasty, and we found no difference in the efficacy of the two routes of administration. Surgeons should be encouraged to use the less expensive oral form of the medication as a means to minimize overall healthcare expenditure.