To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
【摘要】 目的 观察氨甲环酸在肝切除术中止血的有效性和安全性及对凝血功能的影响。 方法 将2009年3-11月间收治的50例肝切除患者，随机分为对照组（C组)和氨甲环酸组（T组)各25例。T组给予氨甲环酸100 mg/kg（总量≤5 g)，C组给予等量生理盐水。于术前30 min先给予负荷量20 mL，剩下的则静脉泵入，泵注速度均为15mL/h。观察患者术中及术后出血和输血总量，比较患者术前和术后24 h血常规和凝血功能状态。 结果 患者术前的一般情况无统计学差异(Pgt;0.05)。T组患者的术中出血和输血量均低于C组（Plt;0.05)，且术后凝血功能改变无统计学意义(Pgt;0.05)。 结论 氨甲环酸在肝切除术中可以有效减少出血和输血量，且对术后凝血功能无显著影响，无严重不良反应，是一种安全有效的止血药物。【Abstract】 Objective To observe the efficiency and safety of tranexamic acid on reducing the hemorrhage in hepatectomy and the effect on blood coagulation. Methods A total of 50 patients with hepatocellular carcinoma who underwent hepatectomy from March to November 2009 were randomly divided into the control group (Group C, n=25) and the tranexamic acid group (Group T, n=25). The patients in Group T were administered to with tranexamic acid (100 g/kg), and the total dosage was not more than 5 g. The patients in Group C were administered to with normal saline, and the dosage was the same as the Group T. Both groups were given loading dose 20 ml, and the rest was intravenous pumped by 15 mL/h. The total bleeding volume, blood transfusion, blood routine and coagulation before surgery and 24 hours after surgery were compared between the two groups. Results The backgrounds, operative procedures did not differ much between the two groups. The total bleeding volume and blood transfusion in Group T were less than that in Group C, and coagulation did not changed evidently. Conclusion In the operation of hepatectomy, tranexamic acid can decrease hemorrhage and transfusion effectively, and would not change coagulation and has no serious adverse effect. It is a kind of safe and effective antihemorrhagic.
ObjectiveTo discuss the effectiveness and safety of intravenous application of tranexamic acid in reducing the blood loss in the perioperative period of lumbar fusion surgery. MethodsA retrospective study of 68 patients with degenerative lumbar spinal stenosis with lumbar instability who were treated with lumbar fusion surgery from March 2013 to March 2014 in West China Hospital was carried out. The patients were divided into tranexamic acid group and control group according to whether tranexamic acid was used. After induction of anesthesia, tranexamic acid was given by intravenous drop to patients in the tranexamic acid group, while the control group did not receive any hemostatic drug. The red blood cell count, hemoglobin, mean corpuscular volume, prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin, intraoperative blood loss, postoperative blood loss, and blood transfusion volume before and after operation were compared. And we also observed whether there was pulmonary embolism or deep vein thrombosis incident. ResultsIt showed no significant difference in intraoperative blood loss between the two groups, but the tranexamic acid group had less blood loss after operation than that of the control group (P<0.05). The tranexamic acid group had a higher red blood cell count, hemoglobin and mean corpuscular volume after operation than that of the control group (P<0.05). There was no significant difference between the two groups in prothrombin time, activated partial thromboplastin time, fibrinogen metaglobulin before and after operation (P>0.05). The pulmonary embolism and deep vein thrombosis were not found in the two groups. ConclusionIntravenous application of tranexamic acid is safe and effective in posterior lumbar fusion surgery. It can reduce the postoperative blood loss significantly, without increasing the risk of pulmonary embolism and deep vein thrombosis.
ObjectiveTo review trauma-induced coagulopathy and use of tranexamic acid in patients with traumatic hemorrhage. MethodsThe relevant literatures about the definition and pathogenesis of trauma-induced coagulopathy, and the use of tranexamic acid in patients with traumatic hemorrhage were reviewed. ResultsTraumatic-induced coagulopathy was a coagulation disorder in the early stage after injury, which was associated with the anticoagu-lation and increasing activity of fibrinolysis. Tranexamic acid as an anti-fibrinolytic drug, it had a good result in clinical application, which could reduce the mortality due to bleeding in use within 3 h after injury, the effect was the best in use within 1 h after injury, but it had no benefit or even would increase the mortality due to hemorrhage in use >3 h after injury. There was no standardized dosage of tranexamic acid, but the volumes of blood loss and blood transfusion had no difference under the different dosages. However, high dosage or long-term use of tranexamic acid might increase the risk of the thrombosis or epilepsy. ConclusionEmergency traumatic patients face a series of death threats related trauma. Appropriate and timely hemostasis is important for prognosis. Early, short-term, and appropriate dosage of tranexamic acid could obviously reduce mortality and adverse events, but its timing and dosages need to be further optimized.
ObjectiveTo investigate the safety and effectiveness of using tranexamic acid in total knee arthroplasty (TKA). MethodsBetween May 2012 and May 2013, 88 patients (88 knees) with degenerative osteoarthritis underwent primary TKA and were divided into 2 groups (n=44) according to whether use of tranexamic acid (15 mg/kg) or not. Seventy-seven patients (39 in trial group and 38 in control group) were enrolled in this study except 11 patients who failed to be followed up. There was no significant difference in gender, age, disease duration, body mass index, osteoarthritis grading, and preoperative general data of laboratory examination between 2 groups (P > 0.05). The following indexes were recorded and compared between 2 groups: intraoperative tourniquet time, intraoperative blood loss, postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, the number of transfusion, postoperative haemoglobin (Hb) at 3 days, postoperative D-dimer at 24 hours, ecchymosis, and deep venous thrombosis (DVT). ResultsNo statistically significant difference was found in intraoperative tourniquet time and intraoperative blood loss between 2 groups (P > 0.05). The postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, and postoperative D-dimer at 24 hours in trial group were significantly lower than those in control group (P < 0.05). The postoperative Hb at 3 days in trial group was significantly higher than that in control group (t=4.815, P=0.000). Three cases (7.7%) of trial group and 4 cases (10.5%) of control group were given blood transfusion, showing no significant difference (P > 0.05); DVT occurred in 3 cases of 2 groups repectively (7.7%, 7.9%), showing no significant difference (P > 0.05). Extremity ecchymosis occurred in 1 case (2.6%) of trial group and in 7 cases (18.4%) of control group, showing significant difference (χ2=0.029, P=0.026). ConclusionUse of tranexamic acid can significantly reduce blood loss and does not increase the risk of DVT after TKA.
ObjectiveTo investigate the safety and efficiency of intravenous tranexamic acid (TXA) to reduce blood loss in total knee arthroplasty (TKA). MethodsA prospective, randomized, self-controlled study was carried out on 60 patients scheduled for bilateral TKA between January 2012 and December 2013. TXA (10 mg/kg) was injected intravenously approximately 10 minutes before tourniquet release when TKA was performed on one side (TXA group), and TXA was not used on the other side (control group). No significant difference was found in the preoperative hemoglobin (Hgb), platelet (PLT) count, prothrombin time (PT), and activated partial thromboplastin time (APTT) between 2 groups (P>0.05). The amount of drainage, the total blood loss, the hidden blood loss, the postoperative Hgb, the amount of blood transfusion, the ratio of blood transfusion, and the incidence of vein thrombosis embolism (VTE) were compared between 2 groups. ResultsThe amount of drainage and total blood loss were significantly less in the TXA group than in control group (P<0.05), and the Hgb was significantly lower in the control group than in the TXA group at 6 hours, 1, 3, and 7 days after operation (P<0.05). There was no significant difference in the hidden blood loss between 2 groups (t=1.157, P=0.252). The ratio of blood transfusion was significantly less in TXA group (6.7%, 4/60) than in control group (21.7%, 13/60)(P=0.034). The total amount of blood transfusion was 14 units in TXA group, which was significantly less than that of control group (38 units) (P=0.004). Deep vein thrombosis occurred in 3 cases in 2 groups respectively, showing no significant difference (P=1.000). There was no symptomatic pulmonary embolism. All patients were followed up for 8-17 months, with an average of 13.7 months. No new VTE case was found during the follow-up period. ConclusionIntravenous injection of TXA (10 mg/kg) at 10 minutes before tourniquet release in TKA is effective in reducing perioperative blood loss, amount of blood transfusion, and ratio of transfusion, and it will not increase the risk of VTE.
ObjectiveTo evaluate the blood protective effect of tranexamic acid on cardiopulmonary bypass in adult congenital heart disease patients. MethodsThere were 84 patients (37 males, 47 females) with congenital heart disease under-going extracorporeal circulation, aged from 18 to 50 years in iur hospital from June through December 2015. All patients were divided into two groups include a control group (group A) with 35 patients and a tranexamic acid group (group B) with 49 patients. After induction of anesthesia, the group B was given tranexamic acid 1 g, and then at rate of 400 mg/h continuous infusion till the end of operation. The group A was given equal volume of physiological saline. Before and after operation and withdrawing of the drainage, the levels of hemoglobin (Hb), platelet (PLt) and international normalized ratio (INR) were tested by taking the central venous blood samples. Chest tube drainage volume, use of red blood cells and plasma after opera-tion were recorded. ResultsNo statistical difference was found between the two groups in Hb, PLT, or INR before opera-tion and usage of blood after operation (P>0.05). Compared with the group A, postoperative chest tube drainage, the use of plasma were lower (P<0.05) in the group B. There was a statistical difference between two groups in Hb, PLT, INR after operation, and withdrawing of the drainage (P<0.05), respectively, while no statistical difference in PLT at withdrawing of drainage was foud. No in-hospital mortality or postoperative complication occurred. ConclusionTranexamic acid has protective effest on blood in adult patients with congenital heart disease undergoing cardiac surgery under cardiopulmonary bypass.
Objective To investigate the effect and safety of time of temporarily-closed wound drainage on blood loss of primary total knee arthroplasty (TKA) after intravenous and intra-articular injection of tranexamic acid (TXA). Methods Eighty female patients were selected from 102 patients who underwent primary TKA between September 2015 and July 2016, who were randomly divided into 4 groups: control group (group A), 30 minutes group (group B), 60 minutes group (group C), and 90 minutes group (group D), 20 patients each group. No significant difference was found in age, body mass index, side, pathogen, duration, and preoperative hemoglobin, albumin, and hematocrit between 4 groups (P>0.05). All the patients received intravenous injection of 1 g TXA at 10 minutes before removing the tourniquet. The patients in group A were injected with 60 mL normal saline into the articular cavity and closed drainage after surgery, while the patients in groups B, C, and D were injected with 60 mL TXA into the articular cavity and closed drainage for 30, 60, and 90 minutes respectively. The volume of drainage at 24 hours after operation, the total blood loss, the postoperative hemoglobin level, maximum hemoglobin loss, albumin loss, the volume and frequency of blood transfusion, venous thrombo embolism rate, and pulmonary embolism rate were recorded and compared between groups. Results The volume of drainage and total blood loss in groups B, C, and D were less than those of group A, showing significant difference between groups C, D and group A (P<0.05), but no significant difference between group B and group A (P>0.05). The volume of drainage at 24 hours after operation in group B was higher than that in groups C and D, showing significant difference between groups B and D (P<0.05), but no significant difference was found between groups C and D (P>0.05). There was no significant difference in the total blood loss between groups B, C, and D (P>0.05). The hemoglobin loss and albumin loss gradually decreased from groups A to D, but no significant difference was found between groups (P>0.05). No venous thrombo embolism and pulmonary embolism occurred. The hemoglobin value decreased to 28 g/L at 3 days after operation in 1 patient of group D, who received venous transfusion of 20 g human albumin. Conclusion Intravenous and topical application of TXA in TKA can significantly decrease postoperative bleeding. Topical TXA combined with 60 minutes temporarily-closed wound drainage may reduce postoperative blood loss to the greatest extent without increasing the risk of venous thrombo and pulmonary embolism event after TKA．