Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement RESULTS OF 3000 PROCEDURES

被引:83
作者
Irwin, A. [2 ]
Khan, S. K. [2 ]
Jameson, S. S. [1 ,2 ]
Tate, R. C. [2 ]
Copeland, C. [2 ]
Reed, M. R. [2 ]
机构
[1] Wansbeck Gen Hosp, Northumbria Healthcare NHS Fdn Trust, Dept Trauma & Orthopaed, Ashington NE63 9JJ, England
[2] Wansbeck Gen Hosp, Northumbria Healthcare NHS Fdn Trust, Ashington NE63 9JJ, England
关键词
BLOOD-LOSS; ARTHROPLASTY; METAANALYSIS; PHARMACOKINETICS;
D O I
10.1302/0301-620X.95B11.31055
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
In our department we use an enhanced recovery protocol for joint replacement of the lower limb. This incorporates the use of intravenous tranexamic acid (IVTA; 15 mg/kg) at the induction of anaesthesia. Recently there was a national shortage of IVTA for 18 weeks; during this period all patients received an oral preparation of tranexamic acid (OTA; 25 mg/kg). This retrospective study compares the safety (surgical and medical complications) and efficacy (reduction of transfusion requirements) of OTA and IVTA. During the study period a total of 2698 patients received IVTA and 302 received OTA. After adjusting for a range of patient and surgical factors, the odds ratio (OR) of receiving a blood transfusion was significantly higher with IVTA than with OTA (OR 0.48 (95% confidence interval 0.26 to 0.89), p = 0.019), whereas the safety profile was similar, based on length of stay, rate of readmission, return to theatre, deep infection, stroke, gastrointestinal bleeding, myocardial infarction, pneumonia, deep-vein thrombosis and pulmonary embolism. The financial benefit of OTA is (sic)2.04 for a 70 kg patient; this is amplified when the cost saving associated with significantly fewer blood transfusions is considered. Although the number of patients in the study is modest, this work supports the use of OTA, and we recommend that a randomised trial be undertaken to compare the different methods of administering tranexamic acid.
引用
收藏
页码:1556 / 1561
页数:6
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