关键词: Administration topical Surgical blood loss Total knee replacement Tranexamic acid

Mesh : Administration, Topical Aged Antifibrinolytic Agents / administration & dosage adverse effects Arthroplasty, Replacement, Knee / adverse effects methods Blood Loss, Surgical / prevention & control Blood Transfusion / statistics & numerical data Blood Volume Cementation / methods Female Hemoglobins / analysis Humans Male Outcome and Process Assessment, Health Care Postoperative Care / methods statistics & numerical data Postoperative Hemorrhage / blood prevention & control therapy Risk Adjustment / methods Thromboembolism / blood diagnosis etiology prevention & control Tranexamic Acid / administration & dosage adverse effects

来  源:   DOI:10.1007/s00590-020-02656-9

Abstract:
OBJECTIVE: Tranexamic acid (TXA) has been shown to be effective in reducing blood loss after total knee replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use, to reduce blood loss after primary total knee replacement without tourniquet, and to compare these outcomes with a control group that did not receive tranexamic acid.
METHODS: This is a prospective, randomized study to assess the effect of a 2-g topical tranexamic acid in 50 mL physiological saline solution in total knee replacement without tourniquet and drain. Primary outcomes were total blood loss. Secondary outcomes were hemoglobin and hematocrit level, hemoglobin and hematocrit drop, transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events.
RESULTS: Preoperative and intraoperative data were similar between the two groups. The mean total blood loss was 620 mL in the topical tranexamic acid group and 1094 mL in the control group with significant differences (p = 0.001), which meant 43% reduction in total blood loss. The hemoglobin and hematocrit postoperative value was significantly higher in the topical tranexamic acid group than in the control group (p = 0.002). Transfusion rates were 0% in the topical tranexamic group and 4.3% in the control group. The length of stay was significantly lower in the topical tranexamic acid group (p = 0.01). There were no DVT or PE in any group.
CONCLUSIONS: A single dose of 2-g TXA in 50 mL topical administration significantly reduces blood loss and improves postoperative blood chemistries in patients undergoing unilateral primary cemented TKA without tourniquet and drain compared to a control group, without increasing the risk of thromboembolic complications.
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