Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery
Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery
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DOI：
10.3928/01477447-20160301-05
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发表时间：
2016-03-01
期刊：
影响因子：
1.1
通讯作者：
Woolf, Shane K.
中科院分区：
文献类型：
--
作者：
Lin, Zilan X.;Woolf, Shane K.
围手术期出血和术后出血在侵入性外科手术（包括骨科手术）中很常见。氨甲环酸（TXA）是一种药理学药物，通过抗纤维蛋白溶解机制稳定形成的凝块并减少活动性出血。它已成功地用于骨科手术，以减少围手术期失血，特别是在全髋关节和膝关节置换术和脊柱手术。许多研究报告了骨科病例的良好安全性和有效性，尽管其管理没有通用标准，其使用尚未成为实践标准。报告的给药方法通常取决于外科医生的偏好，局部和静脉途径均显示有效性。手术的类型和解剖部位似乎会影响决策，但也会导致相互矛盾的意见。据报道，使用TXA的并发症发生率很低。动脉和静脉血栓栓塞事件的发生率，特别是深静脉血栓形成和肺栓塞，尚未发现与健康患者使用TXA有显著差异。给药途径和剂量似乎也不会影响并发症发生率。然而，关于高危患者的数据不足。此外，在已发表的研究中，TXA显示出不同程度地减少失血量、输血率和输血量、围手术期血红蛋白变化和医院相关费用的潜力。血液制品的保存、实验室成本的降低和住院时间的缩短可能是推动与TXA使用相关的成本节约的主要因素。本文综述了目前支持TXA在骨科手术中的安全性、有效性和成本效益的数据。
Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.