Efficacy and Safety of Aspiration and Intra-Articular Injection of Tranexamic Acid in Acute Knee Hemarthrosis of Adult Haemophilic Patients: A Randomized Clinical Trial Study

IF 3 2区 医学 Q2 HEMATOLOGY
Haemophilia Pub Date : 2025-02-07 DOI:10.1111/hae.70000
Seyed Hadi Kalantar, Mohammadreza Razzaghof, Younes Noshadi, Mohammad Ayati Firoozabadi, Gholamreza Toogeh, Jeyran Zebardast, Katayoon Karimi, Behzad Nejad Tabrizi, Seyed Mohammad Javad Mortazavi
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引用次数: 0

Abstract

Introduction

Hemarthrosis, particularly in the knee, accounts for most bleeding episodes in haemophilia. While joint aspiration has proven effective, the role of intra-articular (IA) tranexamic acid (TXA) in managing acute hemarthrosis remains unexplored.

Aim

To assess the efficacy and safety of knee aspiration followed by IA TXA injection in acute haemophilic knee hemarthrosis.

Methods

Forty-four adult haemophilia patients with acute knee hemarthrosis (< 24 h) were randomized to undergo joint aspiration with (TXA group) or without (non-TXA group) IA TXA (1.5 g/15 mL) injection. Both groups received 75 mL injections, including 5 mL of 2% lidocaine and additional 0.9% saline. Ultrasound confirmed hemarthrosis, and standardized factor replacement was given pre-procedure. Primary outcomes included knee range of motion (ROM) and visual analogue scale (VAS) for pain. The significance was set at p < 0.05.

Results

Final analysis included 21 and 17 male patients in the TXA and non-TXA groups, respectively. The TXA group showed a significantly greater knee ROM on days 3, 7, and 14 (p < 0.05), with no differences beyond Day 14. VAS pain scores were significantly lower in the TXA group at 24 h, 3 days, and 7 days post-procedure (p < 0.05). TXA patients reported faster return to work (p = 0.004) and higher satisfaction (p = 0.01). Hemarthrosis recurrence was lower in the TXA group (5.9% vs. 14.3% at 6 weeks; 64.7% vs. 90.5% at 6 months), though differences were not statistically significant. No complications were observed.

Conclusion

Joint aspiration with IA TXA is safe and effective for short-term ROM improvement and pain relief in acute haemophilic knee hemarthrosis.

氨甲环酸吸入和关节内注射治疗成人血友病患者急性膝关节血肿的疗效和安全性:一项随机临床试验研究。
血友病中出血发作的主要原因是关节出血,尤其是膝关节出血。虽然关节抽吸已被证明是有效的,但关节内(IA)氨甲环酸(TXA)在治疗急性关节血肿中的作用仍未被探索。目的:评价急性血友病膝关节血肿患者膝关节抽吸后注射IA TXA的疗效和安全性。方法:选取44例急性膝关节血友病(< 24 h)患者,随机分为联合(TXA组)和不联合(非TXA组)注射IA TXA (1.5 g/15 mL)两组。两组均注射75 mL,其中2%利多卡因5 mL,另加0.9%生理盐水。超声确认关节积血,术前给予标准化因子置换。主要结果包括膝关节活动度(ROM)和疼痛的视觉模拟评分(VAS)。p < 0.05为显著性。结果:最终分析包括21例和17例男性TXA组和非TXA组。TXA组在第3天、第7天和第14天膝关节ROM明显增加(p < 0.05),第14天以后无差异。TXA组患者术后24 h、3 d、7 d VAS疼痛评分均明显降低(p < 0.05)。TXA患者恢复工作更快(p = 0.004),满意度更高(p = 0.01)。6周时,TXA组的关节出血复发率较低(5.9% vs. 14.3%;64.7% vs. 6个月时的90.5%),但差异无统计学意义。无并发症发生。结论:急性血友病膝关节血肿患者联合抽吸IA TXA治疗短期内ROM改善和疼痛缓解安全有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Haemophilia
Haemophilia 医学-血液学
CiteScore
6.50
自引率
28.20%
发文量
226
审稿时长
3-6 weeks
期刊介绍: Haemophilia is an international journal dedicated to the exchange of information regarding the comprehensive care of haemophilia. The Journal contains review articles, original scientific papers and case reports related to haemophilia care, with frequent supplements. Subjects covered include: clotting factor deficiencies, both inherited and acquired: haemophilia A, B, von Willebrand''s disease, deficiencies of factor V, VII, X and XI replacement therapy for clotting factor deficiencies component therapy in the developing world transfusion transmitted disease haemophilia care and paediatrics, orthopaedics, gynaecology and obstetrics nursing laboratory diagnosis carrier detection psycho-social concerns economic issues audit inherited platelet disorders.
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