THE DOSE-RESPONSE RELATIONSHIP OF TRANEXAMIC ACID
THE DOSE-RESPONSE RELATIONSHIP OF TRANEXAMIC ACID
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DOI：
10.1097/00000542-199502000-00009
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发表时间：
1995-02-01
期刊：
影响因子：
8.8
通讯作者：
PARMET, JL
中科院分区：
文献类型：
--
作者：
HORROW, JC;VANRIPER, DF;PARMET, JL
背景：预防性应用抗纤溶药物氨甲环酸可减少心脏手术后出血和输血。然而，氨甲环酸用于此目的的最佳剂量仍然未知。方法：采用前瞻性、随机、双盲的方法，将148例体外循环心脏手术患者随机分为6组：安慰剂组和5组，每组148例，术前给予氨甲环酸负荷量（2.5 ~ 40 mg.kg（-1）），1/10负荷量，每小时1次，共12 h。在12小时内通过胸管收集的血液质量代表失血量。同种异体输血在12小时内和5天内的surgical.Results：六组呈现相似的人口统计学。与氨甲环酸组相比，安慰剂组患者术后D-二聚体浓度升高。与接受安慰剂的患者（552 g，P < 0.05）相比，接受至少10 mg氨甲环酸后再接受1 mg. kg（-1）.h（-1）的患者流血的mg.kg。氨甲环剂量不影响输血。只有初始红细胞压积影响患者是否在手术后5天内接受同种异体输血（红细胞压积每绝对下降3%，比值比为2.08）。结论：预防性氨甲环酸，10 mg.kg（-1），随后1 mg.kg（-1）.h（-1），减少体外循环后出血。较大剂量不会提供额外的止血获益。
Background: Prophylactic administration of the antifibrinolytic drug tranexamic acid decreases bleeding and transfusions after cardiac operations. However, the best dose of tranexamic acid for this purpose remains unknown. This study explored the dose-response relationship of tranexamic acid for hemostatic efficacy after cardiac operation.Methods: In prospective, randomized, double-blinded fashion, 148 patients undergoing cardiac operation with extracorporeal circulation were divided into six groups: a placebo group and five groups receiving tranexamic acid in loading doses before incision (range 2.5 to 40 mg.kg(-1)) and one-tenth the loading dose hourly for 12 h. The mass of blood collected by chest tubes over 12 h represented blood loss. Allogeneic transfusions within 12 h and within 5 d of surgery were tallied.Results: The six groups presented similar demographics. Patients receiving placebo had increased postoperative D-dimer concentration compared to groups receiving tranexamic acid. Patients receiving at least 10 mg.kg(-1) tranexamic acid followed by 1 mg.kg(-1).h(-1) bled significantly less (365, 344, and 369 g.12 h(-1), respectively, for those three groups) compared with patients who received placebo (552 g, P < 0.05). Tranexamic dose did not affect transfusions. Only initial hematocrit affected whether a patient received an allogeneic transfusion within 5 days of operation (odds ratio 2.08 for each 3% absolute decrease in hematocrit).Conclusions: Prophylactic tranexamic acid, 10 mg.kg(-1) followed by 1 mg.kg(-1).h(-1), decreases bleeding after extracorporeal circulation. Larger doses do not provide additional hemostatic benefit.