氨甲环酸在全膝关节置换中的应用及安全性

Application and safety of tranexamic acid in total knee arthroplasty

BACKGROUND: Studies suggested that blood loss was great during total knee arthroplasty, even blood transfusion was needed. Application of the tourniquet will destroy the coagulation system, and is not conducive to hemostasis after replacement. Recently, tranexamic acid has been extensively used to reduce blood loss during total knee arthroplasty, because of low price, simple administration pathway, and effective effects on hemostasis. OBJECTIVE: To summarize the application and safety of tranexamic acid in total knee arthroplasty. METHODS: The first author retrieved PubMed and Chinese Journal Full Text Database for articles from inception to October 2015. The key words were tranexamic acid, total knee arthroplasty, hemorrhage. More than 200 articles were retrieved, and finally 50 articles met the inclusion criteria. RESULTS AND CONCLUSION: Tranexamic acid is a fibrinolytic inhibitor, can reversibly block the binding of plasminogen to fibrin, effectively inhibit fibrinolysis, and reduce hemorrhage after total knee arthroplasty. Nevertheless, there were significant differences in the use, dose and effect of tranexamic acid on hemostasis among different studies. Tranexamic acid was an effective drug for hemostasis during total knee arthroplasty. During total knee arthroplasty, tranexamic acid had been used to reduce dominant blood loss and hidden blood loss after arthroplasty, and could not increase the risk for venous thrombosis of lower limb. Currently, the timing of use, dosage, route of administration, and possible complications of tranexamic acid remain controversial.