Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty

被引:138
作者
Jansen, AJ
Andreica, S
Claeys, M
D'Haese, J
Camu, F
Jochmans, K
机构
[1] Free Univ Brussels, Akad Ziekenhuis, Dept Anaesthesiol, B-1090 Brussels, Belgium
[2] Free Univ Brussels, Akad Ziekenhuis, Dept Haematol, B-1090 Brussels, Belgium
关键词
blood; coagulation; anticoagulants; loss; transfusion; replacement; pharmacology; tranexamic acid; surgery; orthopaedic;
D O I
10.1093/bja/83.4.596
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
We have investigated the effect of treatment with tranexamic acid, an inhibitor of fibrinolysis, on blood loss, blood transfusion requirements and blood coagulation in a randomized, double-blind, placebo-controlled study of 42 patients after total knee arthroplasty. Tranexamic acid 15 mg kg(-1) (n = 21) or an equivalent volume of normal saline (n = 21) was given 30 min before surgery and subsequently every 8 h for 3 days. Coagulation and fibrinolysis values, blood loss and blood units administered were measured before administration of tranexamic acid, 8 h after the end of surgery and at 24 and 72 h after operation. Coagulation profile was examined (bleeding time, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), plasminogen, beta-thromboglobulin and fibrinogen). Fibrinolysis was evaluated by measurement of concentrations of D-dimer and fibrinogen degradation products (FDP). Total blood loss in the tranexamic acid group was 678 (sD 352) mi compared with 1419 (607) mi in the control group (P < 0.001), and occurred primarily during the first 24 h after surgery. Thirteen patients received 1-5 u. of packed red blood cells in the control group compared with two patients in the tranexamic acid group, who received 3 u. (P < 0.001). Postoperative packed cell volume values were higher in the tranexamic acid group despite fewer blood transfusions. Postoperative concentrations of plasminogen were decreased significantly in the tranexamic acid group (P < 0.001). Platelet count, PT, aPTT, bleeding time, beta-thromboglobulin, fibrinogen and FDP concentrations did not differ between groups, but D-dimer concentrations were increased in the control group. Thromboembolic complications occurred in two patients in the control group compared with none in the tranexamic acid group.
引用
收藏
页码:596 / 601
页数:6
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