Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement RESULTS OF 3000 PROCEDURES
Oral versus intravenous tranexamic acid in enhanced-recovery primary total hip and knee replacement RESULTS OF 3000 PROCEDURES
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DOI：
10.1302/0301-620x.95b11.31055
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发表时间：
2013-11-01
影响因子：
4.6
通讯作者：
Reed, M. R.
中科院分区：
文献类型：
--
作者：
Irwin, A.;Khan, S. K.;Reed, M. R.
在我们的科室，我们使用一种增强的恢复方案来进行下肢关节置换术。这包括在麻醉诱导时使用静脉注射氨甲环酸(IVTA；15 mg/kg)。最近，全国静脉注射曲安奈德短缺18周；在此期间，所有患者都接受了口服氨甲环酸制剂(OTA；25毫克/公斤)。这项回顾性研究比较了OTA和IVTA的安全性(手术和内科并发症)和有效性(减少输血需求)。在研究期间，共有2698名患者接受了IVTA，302名患者接受了OTA。在调整了一系列患者和手术因素后，接受输血的优势比(OR)显著高于OTA(OR0.48(95%可信区间0.26-0.89，p=0.019)，而基于住院时间、再住院率、返回医院、深度感染、中风、胃肠道出血、心肌梗死、肺炎、深静脉血栓形成和肺血栓的安全性特征相似。对于70公斤的患者，OTA的经济收益是2.04；当考虑到与显著减少输血相关的成本节省时，这一收益被放大。尽管研究中的患者数量不多，但这项研究支持使用OTA，我们建议进行一项随机试验，比较不同的氨甲环酸给药方法。
In our department we use an enhanced recovery protocol for joint replacement of the lower limb. This incorporates the use of intravenous tranexamic acid (IVTA; 15 mg/kg) at the induction of anaesthesia. Recently there was a national shortage of IVTA for 18 weeks; during this period all patients received an oral preparation of tranexamic acid (OTA; 25 mg/kg). This retrospective study compares the safety (surgical and medical complications) and efficacy (reduction of transfusion requirements) of OTA and IVTA. During the study period a total of 2698 patients received IVTA and 302 received OTA. After adjusting for a range of patient and surgical factors, the odds ratio (OR) of receiving a blood transfusion was significantly higher with IVTA than with OTA (OR 0.48 (95% confidence interval 0.26 to 0.89), p = 0.019), whereas the safety profile was similar, based on length of stay, rate of readmission, return to theatre, deep infection, stroke, gastrointestinal bleeding, myocardial infarction, pneumonia, deep-vein thrombosis and pulmonary embolism. The financial benefit of OTA is (sic)2.04 for a 70 kg patient; this is amplified when the cost saving associated with significantly fewer blood transfusions is considered.Although the number of patients in the study is modest, this work supports the use of OTA, and we recommend that a randomised trial be undertaken to compare the different methods of administering tranexamic acid.