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首页> 外文期刊>BMC Musculoskeletal Disorders >Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty
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Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty

机译：关节内使用氨甲环酸可减少初次全膝关节置换术后的失血量和输血速度

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Tranexamic acid (TXA) is effective in reduction of hemorrhage after major surgical procedures. In total joint replacement it is commonly administered intravenously. Despite various studies regarding the safety of its antifibrinolytic effect there are contraindications for systemic use. In total knee arthroplasty (TKA) TXA can also be administered intraarticular. However, there is a lack of studies focusing on dosage, effectiveness and complications of this local treatment. This study aimed to evaluate if blood loss and transfusion rate can be reduced in primary TKA by local application of TXA. We included a total of 202 consecutive primary, unilateral TKA patients, 101 without and 101 with intraartricular application of 2?g TXA. Surgery was conducted after a standardized protocol. Blood loss, transfusion and complication rates were evaluated until three months after surgery. Blood loss was estimated using the hematocrit-value (Hk) prior and five days after surgery by Rosenecher’s and Mercuriali’s formula. By the use of TXA a significant reduction of blood loss (Rosencher average 1220?ml vs 1900?ml, Mercuriali average 430?ml vs 700?ml p??0,001) and transfusion rate (0% vs 24.75% of patients, p??0,001) was observed. There were no differences regarding complication rates. Due to the lower cost of TXA compared to applied erythrocyte concentrates a side effect of the treatment was a cost reduction of € 1.609 within this cohort. The intraarticular application of 2?g TXA resulted in a significant reduction of blood loss and transfusion rate after primary TKA without increased complication rates. This method therefore seems to be a safe and cost effective instrument to reduce perioperative blood loss. However, it has to be considered that this is an off-label use.
机译：氨甲环酸（TXA）可有效减少主要外科手术后的出血。在全关节置换中，通常是静脉内给药。尽管对其抗纤维蛋白溶解作用的安全性进行了各种研究，但仍存在全身使用的禁忌症。在全膝关节置换术（TKA）中，也可以在关节内施用TXA。但是，缺乏针对这种局部治疗的剂量，有效性和并发症的研究。这项研究旨在评估是否可以通过局部应用TXA来减少原发性TKA中的失血和输血率。我们共纳入202例连续的原发性，单侧TKA患者，101例无动脉和101例经2μgTXA关节腔内应用。手术是在标准化方案之后进行的。评估出血量，输血和并发症发生率，直到术后三个月。根据Rosenecher和Mercuriali的公式，使用手术前和手术后五天的血细胞比容值（Hk）估算失血量。通过使用TXA可以显着减少失血量（Rosencher平均为1220？ml对1900？ml，Mercuriali平均为430？ml对700？ml，p 0.001）和输血率（0％对24.75％的患者，p观察到＜＜ 0.001。并发症发生率没有差异。由于与应用红细胞浓缩液相比，TXA的成本较低，因此该群体的治疗费用降低了1.609欧元。关节内施用2？g TXA可显着减少原发性TKA后的失血量和输血速度，而不会增加并发症的发生率。因此，该方法似乎是减少围手术期失血的安全且经济有效的工具。但是，必须考虑这是标签外用途。

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