Hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid on unicompartmental knee arthroplasty

doi:10.3969/j.issn.2095-4344.2899

Abstract

Abstract:

BACKGROUND: More and more patients are undergoing unicompartmental knee arthroplasty. Tranexamic acid has been injected into the articular cavity in unicompartmental knee arthroplasty in the past, and effects of intravenous combined with topical administration of tranexamic acid in unicompartmental knee arthroplasty have not been studied.

OBJECTIVE: To investigate the hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid in unicompartmental knee arthroplasty.

METHODS: A retrospective analysis was conducted on the medical records of 48 patients with knee

osteoarthritis who underwent primary unilateral unicompartmental knee arthroplasty in the First Department of Orthopedics of Zhongshan People’s Hospital from June 2015 to December 2019. The patients were divided into two groups according to perioperative use of tranexamic acid. The 30 patients in the experimental group received intravenous infusion of 1.0 g tranexamic acid before surgery and 0.5 g tranexamic acid mixed with cocktail before closing the incision. The 18 patients in the control group did not receive tranexamic acid before surgery or cocktail with tranexamic acid before closing the incision. The dominant, hidden and total blood loss of the two groups, the loss of hemoglobin and hematocrit on day 2 after the operation, the number of blood transfusion cases, the duration of postoperative and total hospital stay, and any complications within 30 days after the operation were compared and analyzed.

RESULTS AND CONCLUSION: (1) The dominant, hidden and total blood loss, and the loss of hemoglobin and hematocrit were significantly less in the experimental group than in the control group on day 2 after surgery, with statistically significant differences (P < 0.05). (2) There was no statistically significant difference between the two groups in the number of blood transfusions, postoperative and total hospital stay and any complications within 30 days after surgery (P > 0.05). (3) The results confirmed that the intravenous combined with topical administration of tranexamic acid in the unicompartmental knee arthroplasty has obvious hemostatic effect, and has a certain safety.

Key words: bone, knee, joint, prosthesis, unicondylar replacement, tranexamic acid, vein, blood loss

CLC Number:

Deng Zengfa, He Zhiyong, Liu Kang, Yu Xinping, Liang Jianji, Wang Jinjun, Li Chen, Guo Zhouyang. Hemostatic effect and safety of intravenous combined with topical administration of tranexamic acid on unicompartmental knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5793-5799.

Figures/Tables 5

References

[1] COOK R, DAVIDSON P, WHITE A. Partial knee replacement could be first choice for some patients with osteoarthritis. BMJ. 2019; 367:15994.

[2] MURRAY DW, PARKINSON RW. Usage of unicompartmental knee arthroplasty. Bone Joint J. 2018;100-B:432-435.

[3] ZHANG Z, MIN J, WANG D, et al. Analysis on the occult blood loss after unicompartment knee arthroplasty. China J Orthop Traumatol. 2017; 30: 1013-1017.

[4] 乔松义,孟祥奇,罗斌,等.单髁置换术与全膝置换术治疗膝骨关节炎疗效的Meta分析[J].中华关节外科杂志(电子版),2019,13(2):189-199.

[5] 徐浩,李志杰,李娅娟,等.关节腔灌注氨甲环酸对关节置换术后失血膝关节功能恢复的影响[J].中华实验外科杂志,2017,34(10):1781-1784.

[6] CONLON NP, BALE EP, HERBISON GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg. 2008;106(4):1056-1061.

[7] 龙也,王通,刘佳鑫,等.重组人促红细胞生成素联合铁剂纠正老年股骨转子间骨折患者围术期贫血的临床研究[J].中国修复重建外科杂志,2019,33(6):662-665.

[8] TENGBORN L, BLOMBÄCK M, BERNTORP E. Tranexamic acid--an old drug still going strong and making a revival. Thromb Res. 2015;135:231-242.

[9] SENTILHES L, LASOCKI S, DUCLOY-BOUTHORS AS, et al. Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaesth. 2015;114: 576-587.

[10] WALKER PF, FOSTER AD, ROTHBERG PA, et al. Tranexamic acid decreases rodent hemorrhagic shock-induced inflammation with mixed end-organ effects. PloS One. 2018; 13: e208249.

[11] LEVY JH, KOSTER A, QUINONES QJ, et al. Antifibrinolytic Therapy and Perioperative Considerations. Anesthesiology. 2018; 128:657-670.

[12] SONG SJ, LEE HW, BAE DK, et al. Daily blood loss transition after total knee arthroplasty with topical administration of tranexamic acid: Paradoxical blood loss after action of tranexamic acid. J Orthop Surg (Hong Kong). 2020; 28: 615556104.

[13] LEI Y, XIE J, HUANG Q, et al. The antifibrinolytic and anti- inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop. 2020; 44(3):477-486.

[14] LIU Q, GENG P, SHI L, et al. Tranexamic acid versus aminocaproic acid for blood management after total knee and total hip arthroplasty: A systematic review and meta-analysis. Int J Surg. 2018; 54: 105-112.

[15] DORWEILER MA, BOIN MA, FROEHLE AW, et al. Improved early postoperative range of motion in total knee arthroplasty using tranexamic acid: a retrospective analysis. J Knee Surg. 2019; 32: 160-164.

[16] 褚国庆,刘藜箬,闫明童,等.氨甲环酸静脉联合局部用药减少初次单侧膝关节置换出血[J].中华关节外科杂志(电子版), 2018,12(5):671-675.

[17] 刘新明,陈晓红,殷力.氨甲环酸与混合镇痛药物关节腔注射在TKA手术中应用效果分析[J].中国骨与关节损伤杂志,2018,33(12):1299-1301.

[18] WU J, FENG S, CHEN X, et al. Intra-articular injection of tranexamic acid on perioperative blood loss during unicompartmental knee arthroplasty. Med Sci Monit. 2019;25:5068-5074.

[19] 曾兵,刘刚,贺志盛,等.氨甲环酸关节腔内注射联合置换后3h夹闭引流管对膝关节单髁置换失血量的影响[J].中国组织工程研究,2016, 20(22):3197-3204.

[20] 文涛,薛华明,马童,等.氨甲环酸对减少单髁置换术后出血量的效果评价[J].生物骨科材料与临床研究,2016,13(5):51-54.

[21] 冯硕,吴居泰,查国春,等.关节腔内注射氨甲环酸对单髁置换术围手术期失血量的影响[J].中华骨与关节外科杂志,2016,9(5):402-406.

[22] 罗兵,袁毅,杨家福,等.关节腔注射氨甲环酸并夹闭引流管对膝关节单间室骨性关节炎单髁置换术后出血量的影响[J].中国骨与关节损伤杂志, 2018,33(6):579-582.

[23] POERAN J, RASUL R, SUZUKI S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ.2014;349:g4829.

[24] LÓPEZ-HUALDA Á, DAUDER-GALLEGO C, FERREÑO- MÁRQUEZ D, et al. Efficacy and safety of topical tranexamic acid in knee arthroplasty. Med Clin. 2018;151:431-434.

[25] ZHANG Y, YANG B, SUN X, et al. Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis: A randomized controlled trial. Medicine. 2019; 98: e14458.

[26] DASTRUP A, POTTEGÅRD A, HALLAS J, et al. Perioperative tranexamic acid treatment and risk of cardiovascular events or death after total hip arthroplasty: a population-based cohort study from national danish databases. J Bone Joint Surg Am. 2018; 100: 1742-1749.

[27] WU Y, ZENG Y, HU Q, et al. Blood loss and cost-effectiveness of oral vs intravenous tranexamic acid in primary total hip arthroplasty: A randomized clinical trial. Thromb Res. 2018;171:143-148.

[28] WILDE JM, COPP SN, MCCAULEY JC, et al. One dose of intravenous tranexamic acid is equivalent to two doses in total hip and knee arthroplasty. J Bone Joint Surg. 2018; 100:1104-1109.

[29] EL BEHEIRY H, LUBBERDINK A, CLEMENTS N, et al. Tranexamic acid administration to older patients undergoing primary total hip arthroplasty conserves hemoglobin and reduces blood loss. Can J Surg. 2018; 61: 177-184.

[30] GROSS JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983; 58:277-280.

[31] NADLER SB, HIDALGO JH, BLOCH T. Prediction of blood volume in normal human adults. Surgery. 1962; 51:224-232.

[32] 胡舒,古明晖,蔡立泉,等.氨甲环酸联合铁剂和重组人促红细胞生成素在全髋关节置换术早期康复中的作用研究[J].中华骨与关节外科杂志, 2018,11(3):176-181.

[33] 刘韬,杨建惠,吴敏艳.膝关节单髁置换术与全膝关节置换术治疗单间室膝骨关节炎近中期疗效[J].山西医药杂志,2019,48(14): 1703-1704.

[34] MASARACCHIO M, HANNEY W J, LIU X, et al. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PloS One. 2017; 12: e178295.

[35] SIMAN H, KAMATH AF, CARRILLO N, et al. Unicompartmental knee arthroplasty vs total knee arthroplasty for medial compartment arthritis in patients older than 75 years: comparable reoperation, revision, and complication rates. J Arthroplasty. 2017; 32:1792-1797.

[36] VAN DER LIST JP, SHENG DL, KLEEBLAD LJ, et al. Outcomes of cementless unicompartmental and total knee arthroplasty: A systematic review. Knee. 2017;24:497-507.

[37] 杨玉宝,李海涛,高忠礼,等.氨甲环酸的关节腔灌注对膝关节置换术的影响[J].中华实验外科杂志,2017,34(2):348.

[38] XIE J, ZHANG S, CHEN G, et al. Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study. Br J Clin Pharmacol. 2019; 85: 2089-2097.

[39] HUANG ZY, HUANG Q, ZENG HJ, et al. Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia. BMC Musculoskelet Disord. 2019; 20:402.

[40] LEI Y, XIE J, HUANG Q, et al. The antifibrinolytic and anti-inflammatory effects of a high initial-dose tranexamic acid in total knee arthroplasty: a randomized controlled trial. Int Orthop. 2019.

[41] CHAMBERS S, TIDWELL L, KERKHOF A, et al. Topical tranexamic acid is effective in cementless total knee arthroplasty. Orthop Clin North Am. 2020: 51.

[42] SUKEIK M, ALSHRYDA S, POWELL J, et al. The effect of tranexamic acid on wound complications in primary total Hip Arthroplasty: A meta-analysis. Surgeon. 2020;18(1):53-61.

[43] WANG H, WANG L, LUO Z, et al. Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial. BMC Musculoskelet Disord. 2019;20:478.

[44] HAN X, GONG G, HAN N, et al. Efficacy and safety of oral compared with intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2018;19:430.

[45] FILLINGHAM YA, RAMKUMAR DB, JEVSEVAR DS, et al. The safety of tranexamic acid in total joint arthroplasty: a direct meta-analysis. J Arthroplasty. 2018: 33.

[46] PONGCHAROEN B, RUETIWARANGKOON C. Does tranexamic acid reduce blood loss and transfusion rates in unicompartmental knee arthroplasty? J Orthop Sci. 2016; 21: 211-215.

[47] CLAVÉ A, GAUTHIER E, NAGRA NS, et al. Single-stage bilateral medial Oxford Unicompartmental Knee Arthroplasty: A case-control study of perioperative blood loss, complications and functional results. Orthop Traumatol Surg Res. 2018; 104: 943-947.

[48] LEURCHARUSMEE P, SAWADDIRUK P, PUNJASAWADWONG Y, et al. The possible pathophysiological outcomes and mechanisms of tourniquet-induced ischemia-reperfusion injury during total knee arthroplasty. Oxid Med Cell Longev. 2018; 2018:8087598.

[49] ARTHUR JR, SPANGEHL MJ. Tourniquet use in total knee arthroplasty. J Knee Surg. 2019; 32: 719-729.

[50] 崔丹荔,雷一霆,许宏,等.人工全髋关节置换术中首次大剂量联合术后五次静脉应用氨甲环酸的前瞻性临床研究[J].中国修复重建外科杂志,2019,33(8):935-939.

[51] 和佳,张志红,董智,等.氨甲环酸给药途径对初次单侧全膝关节置换术后出血量影响[J].临床军医杂志,2019,47(7):763-764.

[52] MUFARRIH SH, MALIK AT, QURESHI NQ, et al. The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study. Int J Surg. 2018; 52:25-29.