氨甲环酸结合术后引流管临时夹闭降低单侧全膝置换术后失血量的有效性及安全性

 目的 评估单次静脉应用氨甲环酸结合术后引流管临时夹闭降低单侧全膝关节置换（total knee arthroplasty, TKA）术后失血量的有效性与安全性。方法 2012年7月至2013年6月,前瞻性选择行初次单侧全膝关节置换患者,随机分为氨甲环酸组（松止血带前15 min静脉注入15 mg/kg 氨甲环酸）和安慰剂组（松止血带前15 min给予等量生理盐水）;两组术后均予引流管临时夹闭4 h。记录两组术后12 h引流量、总引流量、输血量、输血人数、术后第1、3、5天血红蛋白值、红细胞压积、术后下肢淤斑发生率、术后24 h D-二聚体值、术后并发症及术后5～7 d下肢静脉超声筛查有无深静脉血栓（DVT）,并对两组进行比较。结果 最终77例患者进入统计学分析。氨甲环酸组39例,安慰剂组38例;两组的人口学资料均匹配。术后12 h引流量为（142.6±202.1） ml（氨甲环酸组）和（257.4±245.3） ml（安慰剂组）、术后隐性失血量为（685.4±40.3） ml （氨甲环酸组）和（834.3±200.0） ml （安慰剂组）、总失血量为（962.2±286.2） ml （氨甲环酸组）和（1 168.4±455.4） ml （安慰剂组）、术后第3天血红蛋白值为（104.0±12.7） g/L（氨甲环酸组）和（96.0±13.4） g/L（安慰剂组）、术后24 h D-二聚体值为（11.8±1.5) mg/L（氨甲环酸组）和（22.1±3.4） mg/L（安慰剂组）,以上指标两组比较差异均有统计学意义。术后下肢淤斑发生率氨甲环酸组（2.6%,1/39）低于安慰剂组（18.4%,7/38）。术后总引流量、围手术期输血率两组比较差异无统计学意义;氨甲环酸组远端深静脉血栓发生率为10.3%（4/39）,安慰剂为7.9%（3/38）,两组比较差异无统计学意义;氨甲环酸组术后第7天出现1例症状性肺栓塞。结论 TKA术后松止血带前15 min按15 mg/kg单次静脉注入氨甲环酸并结合术后临时夹闭引流管4 h,可有效、安全控制术后失血量。     

The role of tranexamic acid in reducing blood loss in total knee replacement

BackgroundTotal knee arthroplasty is associated with significant perioperative blood loss which may necessitate blood transfusion. In this prospective randomised case control study we analysed the efficacy and safety of tranexamic acid in reducing perioperative blood loss and requirement of blood transfusion in total knee arthroplasty.MethodsFourteen patients (group A) undergoing total knee replacement were given intravenous tranexamic acid twice, once ten minutes before tourniquet deflation and once after four hours. Thirteen patients (group B) were observed as a separate group without the administration of the drug. Total perioperative blood loss, need of blood transfusion and D-dimer assay were analysed subsequently.ResultsThe average blood loss in the first group was 266.2 ml and in the second group was 667.5 ml (p < 0.001). average requirement of transfusion in both the groups were 0.54 and 1.6 units of blood respectively (p < 0.001). There was no case of deep vein thrombosis or any other untoward effects.ConclusionHence from these evidences it was concluded that administration of tranexamic acid during total knee replacement helps to reduce blood loss without increasing the risk of deep vein thrombosis.     

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.     

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。     

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。     

全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性

 目的 探讨在全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性。方法 2013年2至5月150例行初次单侧全膝关节置换的女性骨关节炎患者随机分为三组,每组50例。分别在关闭切口前静脉滴注氨甲环酸10 mg/kg（单次使用组）;关闭切口前静脉滴注氨甲环酸10 mg/kg、术后3 h再次按该剂量重复使用（重复使用组）;不使用氨甲环酸（对照组）。比较三组引流量、总失血量、隐性失血量、术后不同时间血红蛋白、输血患者比例、深静脉血栓和肺栓塞发生率。结果 对照组引流量（447.2±101.9） ml,大于单次使用组（273.6±99.6） ml和重复使用组（168.5±80.8） ml,差异有统计学意义。对照组总失血量（1 100.8±288.3） ml,大于单次使用组（959.1±291.7） ml和重复使用组（818.7±206.9） ml,差异有统计学意义。三组隐性失血量的差异无统计学意义。对照组术后第1、3、5天的血红蛋白均低于单次使用组和重复使用组,重复使用组均高于单次使用组,差异有统计学意义。三组输血患者比例分别为8.0%（4/50）、6.0%（3/50）和22.0%（11/50）,对照组高于单次使用组和重复使用组,差异有统计学意义。术后90 d内均未出现症状性深静脉血栓和肺栓塞。结论 全膝关节置换术中关闭切口前静脉滴注氨甲环酸10 mg/kg能有效减少围手术期失血量和降低输血患者比例,术后3 h重复使用能进一步减少失血量,但不能进一步降低输血患者比例。使用氨甲环酸不增加深静脉血栓和肺栓塞发生的风险。     

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。     

Comparison of Topical and Intravenous Tranexamic Acid on Blood Loss and Transfusion Rates in Total Hip Arthroplasty

The objective of this study was to determine whether topical tranexamic acid (TXA) carried similar hemostatic effect compared with intravenous TXA in total hip arthroplasty (THA). Three hundred and three THA patients were enrolled and randomized into 3 groups: no TXA group, topical and intravenous TXA group. The results showed that the topical and intravenous TXA group had reduced but similar blood transfusion rates (5.88% v. s. 5.94%, P = 0.816). No significant difference was detected in total blood loss between the two TXA groups [(963.4 ± 421.3) ml vs. (958.5 ± 422) ml P = 0.733]. We conclude that topical use of TXA was equally effective and safe compared with intravenous TXA in reducing blood loss and transfusion rate following THA without substantial 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.     

Combination of Intravenous and Topical Application of Tranexamic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

This study was aimed to determine the efficacy and safety of combined intravenous (IV) and topical application of tranexamic acid (TXA) in unilateral total knee arthroplasty (TKA) compared with the IV-TXA. One hundred eight-four patients were enrolled. Participants received either 3 g of IV-TXA or 1.5 g topical TXA combined with 1.5 g IV-TXA. The results revealed that compared with the 3 g IV-TXA, adding 1.5 g topical TXA to 1.5 g IV-TXA in unilateral TKA can have the similar effectiveness in reducing transfusion rate and total blood loss without sacrificing safety. The most important is that by adding topical TXA, patients can gain a smaller maximum decline of hemoglobin (Hb), less drainage volume, less postoperative knee pain, less knee swelling, shorter length of hospital stays and higher short-term satisfaction.     

局部应用氨甲环酸不放置引流对降低全膝置换隐性失血的疗效

目的探讨局部应用氨甲环酸、不放置引流对降低人工全膝关节置换(TKA)后隐性失血的疗效。方法选择60例行单侧TKA患者,随机分两组,A组(30例):关节腔内应用氨甲环酸,不放置引流;B组(30例):不应用氨甲环酸,放置引流。比较两组患者术中及术后失血量、隐性失血量、输液量、输血量、患肢周径变化等指标,术前和术后3 h检查D-二聚体和相关凝血指标,术后连续复查血常规。结果术中失血量两组比较差异无统计学意义(P0.05),术后失血量和隐性失血量两组比较差异均有统计学意义(P0.05)。两组术中输液量比较差异无统计学意(P0.05),术后24 h输液量两组比较差异有统计学意义(P0.05)。术后输血量A组(480 ml±140 ml)少于B组(908 ml±248 ml)(P0.05)。术后血红蛋白和红细胞压积B组明显低于A组(P0.05)。术后3 h的D-二聚体A组为(0.92±0.45)mg/L,B组为(1.22±0.67)mg/L,均明显高于术前的(0.36±0.12)mg/L和(0.35±0.14)mg/L(P0.05),且B组高于A组(P0.05)。术后凝血指标两组比较差异无统计学意义(P0.05)。两组患肢周径变化差异均无统计学意义(P0.05)。结论TKA中局部应用氨甲环酸、不放置引流明显减少了术后隐性失血量,同时减少了输血量和输血率,且不影响凝血功能。     

Blood loss reduction: effect of different knee prosthesis designs and use of tranexamic acid—a randomized controlled trial

Purpose

In regard to blood loss in total knee arthroplasty (TKA), the effect of either knee prosthesis designs or bone preparation is still unclear. While the benefit of using tranexamic acid (TXA) is well demonstrated, our study aims to determine the effect of different knee prosthesis designs uses and efficacy of blood loss reduction by different routes of TXA administration.

Methods

The 228 patients undergone primary TKA were randomized to determine between open-box and closed-box prosthesis. Among each group, a second randomization was applied to categorize the patients into (1) no use of TXA (No-TXA), (2) intra-articular TXA use (IA-TXA) and (3) intravenous TXA use (IV-TXA). The calculated blood loss (CBL), drain volume (DV) and an average number of units of blood transfused (ANUBT) were blindly evaluated.

Results

The open-box TKA had 85.60 and 63.29 ml (p = 0.02 and p < 0.01) more CBL and DV compared to closed-box TKA. The IA-TXA and IV-TXA significantly reduced CBL by 190.75 and 162.01 ml (p < 0.01 and p < 0.01) and reduced DV by 129.07 and 61.04 ml (p < 0.01 and p = 0.01), respectively, when compared to No-TXA. Patients who received IA and IV-TXA had ANUBT of 0.21 and 0.23 unit, which was significantly lower than 0.42 unit of No-TXA group (p = 0.03).

Conclusions

Use of the different prosthesis designs could significantly affect CBL and DV following TKA. However, the use of either design resulted in a comparable ANUBT. Regardless of prosthetic type, either IA- or IV-TXA could significantly reduce the CBL and ANUBT when compared to No-TXA.

     

氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性评估

目的 探讨氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性.方法 2008年5月至2009年2月,选取98例拟行全膝关节置换术的患者.男35例,女63例.病因:骨性关节炎66例,类风湿关节炎32例.病程2～12年,平均5年.随机分为A、B两组,每组49例:A组在松止血带时将氨甲环酸1 g稀释于250ml生理盐水后静脉点滴,3 h后以相同剂量再次给药;B组仅给予等量生理盐水静脉点滴.以术中失血量、术后可见失血量、输血量、输血人数、术后血红蛋白和术后纤维蛋白原、凝血酶原时间等为评价指标,对两组进行比较.观察患者术后是否出现下肢深静脉栓塞的临床症状,并于术后14d进行下肢血管多普勒检查.结果术中失血量两组比较差异无统计学意义(P>0.05),但术后可见失血量、输血量、输血人数A组均明显少于B组(P<0.05).术后血红蛋白值,A组明显大于B组(P<0.05).两组患者术中松止血带和术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间的比较差异无统计学意义(P>0.05).术后14d未发现卜肢深静脉血栓形成.结论 在全膝关节置换术中及术后短期使用氨甲环酸能明显降低患者失血量及输血量,并且不增加静脉血栓形成的风险.     

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 and re-infusion drains in total knee arthroplasty

Blood loss following total knee arthroplasty (TKA) can be significant. Re-infusion drains and tranexamic acid (TA) are used to minimise blood loss and need for allogenic blood transfusion in TKA. The effect of TA on re-infusion volume of drained blood has received little attention. The aim of this study was to measure the effect of TA on re-infusion volumes in primary TKA. A cohort of consecutive patients undergoing primary TKA under one surgeon between November 2006 and January 2008 were studied. Patients operated upon before June 2007 did not receive TA, while those who underwent surgery after June 2007 received TA. All patients had a re-infusion drain. Pre- and post-operative haemoglobin, re-infusion volume and total volume drained were recorded. There was significantly lower drainage volume (average 250 v 600 ml; P < 0.05) and subsequent re-infusion volume (100 v 465 ml; P < 0.05) in the TA group compared to non-TA group. There were no cases of thromboembolism or allogenic blood transfusions in either group. TA decreased post-operative blood loss and subsequent re-infusion volumes. TA is cost-effective compared to re-infusion drains in TKA. Drainage volume was so low when TA was used in primary TKA that the need for re-infusion drains is questionable.     

氨甲环酸减少全膝关节置换术出血量的临床对比研究

目的探讨抗纤溶药物氨甲环酸对全膝关节置换术出血量的影响。方法2005年6月～2006年6月,选取102例行全膝关节置换术患者。男43例,女59例;年龄59～77岁,平均68岁。病因:骨性关节炎59例,类风湿性关节炎23例,创伤性关节炎20例。病程2～12年。随机分为两组(n=51),A组在松止血带时将氨甲环酸1g稀释于250ml生理盐水后静脉点滴,3h后以相同剂量再次给药;B组仅给予等量生理盐水静脉点滴。记录术中及术后失血量和输血量,观察患者是否出现下肢深静脉栓塞的临床症状;术前、术中松止血带时和术后3h检查D二聚体(D-dimeride,D-dimer)、纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)和活化的部分凝血活酶时间(activated partial throm boplastin time,APPT)。结果A组和B组术中出血量分别为256±149ml和306±214ml(P>0.05);术后引流量分别为478±172ml和814±156ml,总失血量分别为559±159ml和1208±243ml,差异均有统计学意义(P<0.05)。A、B组的输血量分别为556±174ml和1024±278ml(P<0.05);术后连续复查血红蛋白浓度,B组为0.6～0.8g/dl,低于A组的1.0～1.1g/dl。术后获随访6～12个月,经血管超声多普勒检查均未发现下肢深静脉血栓形成。A、B组术后3hD-dimer分别为0.92±0.56、1.32±0.79mg/L,明显高于术前的0.35±0.13、0.37±0.21mg/L,且B组显著高于A组,差异均有统计学意义(P<0.05)。两组间FIB、PT和APPT比较差异无统计学意义(P>0.05)。结论在全膝关节置换术中及术后短期使用氨甲环酸能明显减少患者失血量及输血量,并且不增加静脉血栓形成的风险。     

联合氨甲环酸和肾上腺素对全膝关节置换术失血的研究

目的评价联合使用氨甲环酸(TXA)和稀释的肾上腺素(DEP)对初次全膝关节置换术(TKA)围术期失血量等指标的影响及其安全性。 方法检索电子数据库包括PubMed,荷兰医学文摘数据库(EMBASE),Cochrane对照研究注册中心,Web of Science,万方数据库和中国知网,根据纳入排除标准,包括初次TKA患者的随机对照研究,干预措施实验组为TXA＋DEP,对照组为TXA。采用RevMan 5.2软件进行Meta分析。 结果经过全面严格筛选,共纳入高质量随机对照研究6篇。Meta分析结果显示,使用TXA＋DEP可以减少病人平均总失血量[MD ＝－184.32,95%CI(－251.11,－117.52), P<0.01];平均减少隐性失血量[MD ＝－150.89,95%CI(－179.83,－121.95), P<0.00001];平均减少引流量[MD ＝－63.16,95%CI(－116.29,－10.02), P＝0.02]。联合TXA＋DEP可以显著降低输血率[RR ＝0.51, 95%CI(0.28,0.93), P＝0. 03];两组间深静脉血栓发生率差异无统计学意义(P＝1.00)。 结论联合TXA＋DEP能有效减少初次TKA的失血量和降低输血率,并不增加术后DVT的发生率。     

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。     

Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Background

The optimal administration route of tranexamic acid (TXA) in total knee arthroplasty (TKA), and the effect of TXA on hidden blood loss and total blood loss are undetermined. The purpose of this study was to compare the effectiveness of intravenous versus intra-articular application of tranexamic acid in patients undergoing knee arthroplasty.

The effect of intravenous tranexamic acid use on blood loss after revision shoulder arthroplasty

BackgroundRevision total- and reverse shoulder arthroplasties have become more common as the incidence of primary shoulder arthroplasties rise and the older population grows. The use of tranexamic acid (TXA) to decrease perioperative blood loss has been well established in literatures; however, its use in revision shoulder arthroplasty has yet to be explored. We retrospectively examined the effect of TXA use on perioperative blood loss during revision shoulder arthroplasties.MethodsThis was a retrospective review of patients ≥18 years of age, who underwent revision total- or reverse shoulder arthroplasties at the investigating institution between June 2013 and December 2020. Patients were stratified into 2 groups based on perioperative intravenous (IV) TXA vs. No TXA exposure. Contraindications to IV TXA included a history of blood clots and coagulopathies. Demographics, medical comorbidities, pre- and post-op hemoglobin, drain output, need for transfusion during hospitalization, duration of surgery, length of hospitalization, emergency department visits within 90 days of surgery, readmission to hospital within 90 days of surgery, and development of postoperative hematoma were analyzed.ResultsA total of 192 procedures (90 IV TXA vs. 102 No TXA) were analyzed. The cohorts did not significantly differ in age, gender, body mass index, breakdown of type of revision, or medical comorbidities. Analysis of the cohorts demonstrated that the IV TXA group had a significantly higher preoperative hemoglobin (12.9 vs. 13.5, P = .012) and postoperative hemoglobin (9.6 vs. 10.5, P < .001), as well as a significantly lower exposure to drain placement (75% vs. 43%, P < .001) and lower drain output per day (145 ml vs. 97.5 ml, P < .001) as compared to the No TXA group following revision shoulder arthroplasty. The results favored the IV TXA group with regard to blood loss, transfusions, duration of surgery, length of stay, and hospital readmissions within 90 days; however, these did not reach statistical significance.ConclusionsTXA use in revision shoulder arthroplasty significantly decreased the drain output; however had no significant effect on blood loss or transfusion rates.