Multiple-Dose Intravenous Tranexamic Acid Further Reduces Hidden Blood Loss After Total Hip Arthroplasty: A Randomized Controlled Trial

被引:53
作者
Lei, Yiting [1 ]
Huang, Qiang [1 ]
Huang, Zeyu [1 ]
Xie, Jinwei [1 ]
Chen, Guo [1 ]
Pei, Fuxing [1 ]
机构
[1] Sichuan Univ, West China Hosp, Dept Orthopaed, 37 WainanGuoxue Rd, Chengdu 610041, Sichuan, Peoples R China
关键词
tranexamic acid; total hip arthroplasty; multiple-dose treatment; hidden blood loss; randomized controlled study; TOTAL KNEE ARTHROPLASTY; INFLAMMATORY RESPONSE; ORTHOPEDIC-SURGERY; CLINICAL-TRIAL; ANTICOAGULATION; METAANALYSIS; TOURNIQUET; PREVENTION; BOLUSES; SAFETY;
D O I
10.1016/j.arth.2018.04.024
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
Background: The most appropriate dose of tranexamic acid in total hip arthroplasty (THA) has not been decided. This study was conducted to evaluate the clinical effects of multiple-dose intravenous tranexamic acid (IV-TXA) in THA. Methods: One hundred fifty patients were randomized to receive one dose of IV-TXA before incision, followed by 2 doses of IV-TXA (group A), or 3 doses of IV-TXA (group B), or 4 doses of IV-TXA (group C) at 3-hour intervals. The primary outcome was hidden blood loss (HBL). Other outcome measurements such as total blood loss, maximum hemoglobin (Hb) drop, postoperative lowest Hb level, fibrinolysis parameter (D-dimer), inflammatory factor (interleukin-6), transfusion rate, length of stay, and complications were also compared. Results: The mean HBL, total blood loss, and maximum Hb drop were significantly lower in group C than in groups B and A. Such differences were also detected between groups B and A. The postoperative lowest Hb level was significantly higher in group C. D-dimer and interleukin-6 in group C were significantly lower than in groups B and A at 24 and 48 hours postoperatively. Such differences were also significant between groups B and A. There was no significant difference in length of stay among groups. No patient underwent blood transfusion during hospitalization. No episodes of deep venous thrombosis or pulmonary embolism occurred in all cases. Conclusion: The 5-dose IV-TXA regimen can further diminish HBL, decrease maximum Hb drop, provide additional fibrinolysis control, and ameliorate postoperative inflammatory response following THA. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:2940 / 2945
页数:6
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