The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial
The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial
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DOI：
10.1111/jth.14316
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发表时间：
2018-12-01
影响因子：
10.4
通讯作者：
Zeng, W. -N.
中科院分区：
文献类型：
--
作者：
Wang, D.;Luo, Z. -Y.;Zeng, W. -N.
背景氨甲环酸(TXA)可在不同剂量下减少全膝关节置换术患者的出血量和炎症反应。然而，最佳方案尚未确定。目的探讨最有效的止血方案，最大限度地减少失血和炎症反应。方法275例患者随机分为四组：安慰剂组(A组)，术前2 h单次口服血栓素A 2 g，术后3 h口服血栓素A 1 g(B组)，术后3 h、7 h口服血栓素A 1 g(C组)，术后3 h、7 h、11 h口服血栓素A 1 g(D组)，术后3 h、7 h、11 h、15 h口服血栓素A 1 g(E组)。主要结果是术后第3天的总出血量(POD)。次要结果包括血红蛋白水平、凝血参数、炎症标志物水平和血栓栓塞症并发症的降低。结果与A、B、C组相比，D、E组的出血量明显减少，Hb水平下降幅度较小，POD3差异无统计学意义，4种给药方案均能显著增强凝血功能，但各项血栓弹性图参数均维持在正常范围。E组炎症标志物水平最低，疼痛程度最低，活动范围最大。未发现血栓栓塞症并发症。结论四剂方案能最大限度地减少失血量，减少炎症反应，提高镇痛效果，促进早期康复。需要进一步的研究来确保这些发现是可重现的。
Background Tranexamic acid (TXA) can reduce blood loss and the inflammatory response at multiple doses in total knee arthroplasty patients. However, the optimal regimen has not been determined. Objectives To identify the most effective regimen for achieving maximum reductions in blood loss and the inflammatory response. Patients/Methods Two hundred and seventy-five patients were randomized to receive a placebo (group A), a single 2-g oral dose of TXA 2 h preoperatively followed by 1 g of oral TXA 3 h postoperatively (group B), a single dose followed by 1 g of oral TXA 3 h and 7 h postoperatively (group C), a single dose followed by 1 g of oral TXA 3 h, 7 h and 11 h postoperatively (group D), or a single dose followed by 1 g of oral TXA 3 h, 7 h, 11 h and 15 h postoperatively (group E). The primary outcome was total blood loss on postoperative day (POD) 3. Secondary outcomes included a decrease in the hemoglobin level, coagulation parameters, inflammatory marker levels, and thromboembolic complications. Results Groups D and E had significantly lower blood loss and smaller decreases in hemoglobin level than groups A, B, and C, with no significant difference on POD 3 between groups D and E. Significantly enhanced coagulation was identified for the four multiple-dose regimens; however, all thromboelastographic parameters remained within normal ranges. Group E had the lowest inflammatory marker levels and pain, and the greatest range of motion. No thromboembolic complications were identified. Conclusion The four-dose regimen yielded the maximum reductions in blood loss and inflammatory response, improved analgesia, and promoted early rehabilitation. Further studies are required to ensure that these findings are reproducible.