高危关节置换术患者应考虑使用氨甲环酸

Andy Ho, D. Campbell, S. Yapa, I. Malek, P. Yates
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引用次数: 0

摘要

背景氨甲环酸显著降低关节成形术患者的失血和输血需求。然而,尽管没有证据表明这类患者存在危险,但在既往患有动脉和血栓栓塞疾病的患者中,通常会避免使用这种药物。我们检查了氨甲环酸在未经选择的髋关节和膝关节置换术患者中的使用情况,包括那些被认为是“高危”的患者。方法对接受髋关节或膝关节置换术的患者进行为期2年的回顾性多中心研究。血液管理方案包括所有患者普遍使用氨甲环酸。分析了失血量、输血量和并发症。结果共有958名患者被纳入研究,130名患者被视为血栓栓塞并发症的“高风险”患者,828名患者被认为是“低风险”患者。879名患者接受了氨甲环酸治疗,这些患者的失血量显著减少(p<0.001)。130名“高危”患者中有2名(1.5%)和828名“低风险”患者中的14名(1.7%)患有术后VTE。“高风险”和“低风险”患者之间的VTE发生率没有显著差异(p=0.6),或在接受过TXA的“高风险“患者亚组中(p=1)。结论氨甲环酸的疗效是压倒性的,并且超过了任何潜在的风险。氨甲环酸应考虑用于所有关节成形术患者,包括有静脉或动脉血栓形成病史的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tranexamic Acid Should be Considered for High Risk Arthroplasty Patients
Background Tranexamic acid significantly reduces blood loss and transfusion requirements in arthroplasty patients.  However, it is often avoided in patients who have had previous arterial and thromboembolic disease despite the absence of evidence of hazard in this group of patients. We examined the use of tranexamic acid in unselected hip and knee arthroplasty patients including those considered to be ‘high risk’.   Methods A 2-year retrospective multicentre study was performed with patients who underwent hip or knee arthroplasty surgery. A blood management protocol included universal tranexamic acid use for all patients. Blood loss, transfusion volumes and complications were analysed.   Results A total of 958 patients were included in the study, 130 patients were considered ‘high risk’ of thromboembolic complications and 828 patients were considered ‘low risk’. 879 patients received tranexamic acid with a significant reduction in blood loss (p<0.001) in these patients. Two of 130 (1.5%) ‘high risk’ patients and 14 of 828 (1.7%) ‘low risk’ patients had post-operative VTE. There was no significant difference in rate of VTE between the ‘high risk’ and ‘low risk’ patients (p=0.6) or in the subgroup of ‘high risk’ patients who had received TXA (p=1).   Conclusions The efficacy of tranexamic acid is overwhelming and outweighs any potential risks. Tranexamic acid should be considered for use in all arthroplasty patients including those with prior history of venous or arterial thrombosis.
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