Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation
Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation
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DOI：
10.1097/00000542-199611000-00012
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发表时间：
1996-11-01
期刊：
影响因子：
8.8
通讯作者：
Glynn, MFX
中科院分区：
文献类型：
--
作者：
Boylan, JF;Klinck, JR;Glynn, MFX
背景：终末期肝病患者在肝移植过程中经常发生大量失血，这与机械因素、先前存在的凝血功能障碍和术中纤维蛋白溶解有关。方法：1992年4月至1994年5月，作者进行了一项双盲、随机、安慰剂对照研究，研究了大剂量氨甲环酸（最大20g）对原发性离体原位肝移植患者出血量和血制品需求的影响。主要结局指标为术中失血量（术中失血量和术后引流量）、术中红细胞、血浆、血小板和低温沉淀的使用以及重症监护病房入住的前24小时。结果：与安慰剂组（n = 20；中位数，8 l；四分位数范围，5至15.8）相比，接受转氨酰胺酸治疗的患者（n = 25）术中失血量更少（中位数，4.3 l；四分位数范围，2.5至7.9;P = 0.006），术中血浆、血小板和低温沉淀需求降低。接受转胺酸治疗的患者围手术期红细胞使用量中位数为9个单位（分位数范围为4 ~ 14个单位），对照组为13个单位（分位数范围为7.5 ~ 31个单位）（P = 0.03）。接受转胺酸治疗的患者围手术期供体总暴露量为20.5单位（分位数范围为16 ~ 41单位），对照组为43.5单位（分位数范围为29.5 ~ 79单位）（P = 0.003）。术后伤口引流结果相似。两组患者的住院时间和再次移植需求具有可比性。两组患者均未在移植术后1个月内出现肝动脉或门静脉血栓形成的临床证据。结论：大剂量氨甲环酸可显著减少终末期实质肝病原位肝移植患者术中出血量和围术期供体暴露，血小板和低温沉淀需求显著降低。
Background: Patients with end-stage liver disease frequently incur large-volume blood loss during liver transplantation associated with mechanical factors, preexisting coagulopathy, and intraoperative fibrinolysis.Methods: Between April 1992 and May 1994, the authors of this double-blind, randomized, placebo-controlled study examined the effect of high-dose tranexamic acid (maximum of 20 g) on blood loss and blood product requirements in patients undergoing primary isolated orthotopic liver transplantation. Primary outcome measures were volume of blood loss (intraoperative blood loss and postoperative drainage) and erythrocyte, plasma, platelet, and cryoprecipitate use during surgery and the first 24 h of intensive care unit stay.Results: Patients receiving transexamic acid (n = 25) had less intraoperative blood loss (median, 4.3 l; interquartile range, 2.5 to 7.9; P = 0.006) compared with the placebo group (n = 20; median, 8 l; interquartile range, 5 to 15.8), and reduced intraoperative plasma, platelet, and cryoprecipitate requirements. Median perioperative erythrocyte use was 9 units (interquantile range, 4 to 14 units) in patients receiving transexamic acid and 13 units (interquantile range, 7.5 to 31 units) in controls (P = 0.03). Total perioperative donor exposure was 20.5 units (interquantile range, 16 to 41 units) in patients receiving transexamic acid and 43.5 units (interquantile range, 29.5 to 79 units) in controls (P = 0.003). Results for postoperative wound drainage were similar. Hospital stay and need for retransplantation were comparable in both groups. No patient in either group showed clinical evidence of hepatic artery or portal venous thrombosis within 1 month of transplantation.Conclusions: High-dose tranexamic acid significantly reduces intraoperative blood loss and perioperative donor exposure in patients with end-stage parenchymal liver disease who are undergoing orthotopic liver transplantation, with marked reductions in platelet and cryoprecipitate requirements.