Tranexamic acid combined with iron sucrose reduces blood transfusion in primary total hip arthroplasty: a prospective, randomized, controlled trial

doi:10.3969/j.issn.2095-4344.0341

Abstract

Abstract:

BACKGROUND: Tranexamic acid is a commonly used hemostatic drug in hip arthroplasty, iron sucrose is used for perioperative anemia, and the clinical effect and safety of their combination need to be studied further.

OBJECTIVE: To investigate the clinical efficacy and safety of tranexamic acid combined with iron sucrose in total hip arthroplasty (THA).

METHODS: Among 263 patients undergoing THA at Department of Orthopedics, the First Affiliated Hospital of Kunming Medical University from September 2016 to September 2017, 174 patients were enrolled, and randomly assigned to tranexamic acid combined iron group (combination group), tranexamic acid group and iron group (n=58 per group). The level of hemoglobin and hematocrit were recorded at admission, preoperative 1 day, and postoperative 1, 3, and 5 days postoperatively were recorded. The thrombin time, activated partial thromboplastin time, fibrinogen and D-dimer level were detected at admission and postoperative 1 day. The intraoperative blood loss, postoperative drainage volume and postoperative blood transfusion were recorded. The preoperative blood volume and total blood loss were calculated.

RESULTS AND CONCLUSION: (1) There was no significant difference in the baseline data among groups (P > 0.05). (2) The level of hemoglobin at preoperative 1 day in the combination and iron groups was significantly higher than that in the tranexamic acid group (P < 0.05). The postoperative level of hemoglobin in the combination was significantly higher than that in the other two groups (P < 0.05). (3) The postoperative blood transfusion and total blood loss in the combination group were significantly lower than those in the other two groups (P < 0.05). (4) The coagulation indicators and D-dimer level did not differ significantly among groups (P > 0.05). (5) There were no complications such as articular infection, deep venous thrombosis, and pulmonary embolism during follow-up. (6) To conclude, tranexamic acid combined with iron sucrose can effectively improve the perioperative hemoglobin concentration, and reduce the total blood loss and postoperative blood transfusion, without thrombosis and other complications, which is effective and safe.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Hip, Tranexamic Acid, Tissue Engineering

CLC Number:

R318

Xi Ying-long, Duan Yu-ping, Yang Qing, Yang Yi, Zhang Zheng-xue, Zhao Xiao-dong, Zhou Jun-jie, Yang Jia. Tranexamic acid combined with iron sucrose reduces blood transfusion in primary total hip arthroplasty: a prospective, randomized, controlled trial[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(27): 4288-4293.

Figures/Tables 3

References

[1] Clarke A, Pulikottiljacob R, Grove A, et al. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess. 2015;19(10):1-668.

[2] Wind TC, Barfield WR, Moskal JT. The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty. J Arthroplasty. 2014; 29(2):387-389.

[3] Frisch NB, Wessell NM, Charters MA, et al. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty. 2014;29(9):189-192.

[4] Cherian JJ, Kapadia BH, Banerjee S, et al. Surgical intra-operative blood management strategies for total hip arthroplasty. Surg Technol Int. 2014;24(6):319.

[5] Monsef JB, Boettner F. Blood Management May Have an Impact on Length of Stay After Total Hip Arthroplasty. Hss J., 2014;10(2):124-130.

[6] Muñoz M, Gómezramírez S, Cuenca J, et al. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion. 2014;54(2):289-299.

[7] Aguilera X, Martinezzapata MJ, Bosch A, et al. Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial. J Bone Joint Surg Am. 2013;95(22):2001-2007.

[8] Alshryda S, Mason J, Vaghela M, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). Jbjs. 2013;95(21):1961-1968.

[9] 孟涛,尚希福. 铁剂与氨甲环酸联合应用对单侧全膝关节置换术围手术期失血及安全性的影响[J]. 安徽医学,2015,36(11):1325-1329.

[10] Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery.1962;51(2):224-232.

[11] Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58(3):277.

[12] Blanié A, Bellamy L, Rhayem Y, et al. Duration of postoperative fibrinolysis after total hip or knee replacement: a laboratory follow-up study. Thromb Res. 2013;131(1):e6-e11.

[13] De JT. [Pharmacological reduction of bleeding during hip endoprosthetic replacement]. Orvosi Hetilap. 2012;153(41):1607.

[14] Cram P, Mba MD, Lu X, et al. Clinical Characteristics and Outcomes of Medicare Patients Undergoing Total Hip Arthroplasty, 1991-2008. JAMA. 2011;305(15):1560-1567.

[15] Eeles A, Baikady RR. Peri-operative blood management. Indian J Anaesthes. 2017;61(6):456-462.

[16] Alexander DP, Frew N. Preoperative optimisation of anaemia for primary total hip arthroplasty: a systematic review. Hip Int J Clin Exp Res Hip Pathol Ther. 2017.

[17] Seligsohn U. Treatment of inherited platelet disorders. Haemophilia. 2012;18 Suppl 4(s4):161.

[18] Rodeghiero F. Management of menorrhagia in women with inherited bleeding disorders: general principles and use of desmopressin. Haemophilia. 2008;14 Suppl 1(Supplement s1):21.

[19] Ragni MV, Machin N, Malec LM, et al. Von Willebrand factor for menorrhagia: a survey and literature review. Haemophilia. 2016; 22(3):397-402.

[20] 花京剩,罗爽,郭玲玲,等. 蔗糖铁注射液治疗缺铁性贫血100例临床观察[J]. 中国乡村医药,2013,(24):29-30.

[21] Macdougall IC, Tucker B, Thompson J, et al. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int. 1996;50(5):1694.

[22] Silverberg DS, Blum M, Peer G, et al. Intravenous ferric saccharate as an iron supplement in dialysis patients. Nephron. 1996;72(3):413.

[23] Prasad N, Rajamani V, Hullin D, et al. Post-operative anaemia in femoral neck fracture patients: Does it need treatment? A single blinded prospective randomised controlled trial. Injury. 2009;40(10):1073.

[24] Yang Y, Li H, Li B, et al. Efficacy and Safety of Iron Supplementation for the Elderly Patients Undergoing Hip or Knee Surgery: A Meta-Analysis of Randomized Controlled Trials. J Surg Res. 2011;171(2):201-207.

[25] Irisson E, Hémon Y, Pauly V, et al. Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery. Orthop Traumatol Surg Res. 2012;98(5):477.

[26] Wu YG, Zeng Y, Shen B, et al. Combination of erythropoietin and tranexamic acid in bilateral simultaneous total hip arthroplasty: a randomised, controlled trial. Hip Int. 2016;26(4):331.

[27] 张成欢,刘云,赵建宁,等. 静脉滴注联合局部应用氨甲环酸可减少全髋关节置换后隐性失血[J]. 中国组织工程研究, 2015,19(44):7071-7076.

[28] 李林涛,吴海山,吴宇黎,等. 人工关节置换术围手术期的血液管理策略[J]. 中国修复重建外科杂志, 2015,(6):772-776.

[29] Zufferey PJ, Miquet M, Quenet S, et al. Tranexamic acid in hip fracture surgery: a randomized controlled trial. Br J Anaesth. 2010;104(1):23-30.

[30] 刘丙根,庞清江. 氨甲环酸用于全髋关节置换有效性与安全性的Meta分析[J]. 中国组织工程研究,2014,18(35):5699-5706.

[31] 谢锦伟,岳辰,康鹏德,等. 氨甲环酸减少初次非骨水泥全髋置换围术期失血有效性及安全性研究[J]. 中华骨与关节外科杂志,2014,(6):481-485.

[32] 熊文,郭孝军,曾广军. 氨甲环酸不同给药方式对全髋关节置换术患者凝血功能和出血量的影响[J]. 临床骨科杂志,2017,20(4):452-455.

[33] 曲智俊,曲向东,李玉锦,等. 氨甲环酸对髋翻修患者围术期输血及凝血功能的影响[J]. 中国老年学,2017,37(14):3554-3556.

[34] 闫沛云,宋朝基,苗生龙,等. 全髋人工关节置换术后下肢深静脉血栓的早期诊断[J]. 中国骨与关节杂志,2013,(8):444-447.