The blood-saving effect of tranexamic acid in minimally invasive total knee replacement IS AN ADDITIONAL PRE-OPERATIVE INJECTION EFFECTIVE?

被引:47
作者
Lin, P-C [1 ]
Hsu, C-H [1 ]
Huang, C-C [1 ]
Chen, W-S [1 ]
Wang, J-W [1 ]
机构
[1] Chang Gung Univ, Kaohsiung Chang Gung Mem Hosp, Coll Med, Kaohsiung 83301, Taiwan
来源
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME | 2012年 / 94B卷 / 07期
关键词
TOTAL HIP-ARTHROPLASTY; DEEP-VEIN THROMBOSIS; PNEUMATIC TOURNIQUET; ORTHOPEDIC-SURGERY; TRANSFUSION; REDUCE; MANAGEMENT; RISK; FIBRINOLYSIS; CYKLOKAPRON;
D O I
10.1302/0301-620X.94B7.28386
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
Tranexamic acid (TEA), an inhibitor of fibrinolysis, reduces blood loss after routine total knee replacement (TKR). However, controversy persists regarding the dosage and timing of administration of this drug during surgery. We performed a prospective randomised controlled study to examine the optimum blood-saving effect of TEA in minimally invasive TKR. We randomly assigned 151 patients who underwent unilateral minimally invasive TKR to three groups: 1) a placebo group (50 patients); 2) a one-dose TEA group (52 patients), who received one injection of TEA (10 mg/kg) intra-operatively on deflation of the tourniquet; and 3) a two-dose TEA group (49 patients), who received two injections of TEA (10 mg/kg) given pre-operatively and intra-operatively. Total blood loss was calculated from the maximum loss of haemoglobin. All patients were followed clinically for the presence of venous thromboembolism (VTE). The mean total blood loss was significantly higher in the placebo group than in the other two groups (1222 ml (845 to 2043) versus 1035 ml (397 to 1934) and 986 ml (542 to 1811), respectively (both p < 0.0001)). The mean blood loss was not significantly different between the one- and two-TEA groups (p = 0.148). The mean transfusion rate was higher in the placebo group than in the other two groups (22% versus 3.8% (p = 0.006) and 6.1% (p = 0.041), respectively) and there was no statistically significant difference in the mean transfusion rate between the one- and two-TEA groups (p = 0.672). Only one patient, in the two-dose group, had a radiologically confirmed deep venous thrombosis. Our prospective randomised controlled study showed that one intra-operative injection of TEA is effective for blood conservation after minimally invasive TKR.
引用
收藏
页码:932 / 936
页数:5
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