Safety evaluation of tranexamic acid in reducing perioperative blood loss in high tibial osteotomy

doi:10.3969/j.issn.2095-4344.3786

Abstract

Abstract: BACKGROUND: Tranexamic acid is widely used for its good hemostatic effect in orthopedic surgery, and it is the most mature application in hip and knee arthroplasties. However, the impact on perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis is unknown.
OBJECTIVE: To explore the effect of tranexamic acid on the perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis.
METHODS: From June 2017 to December 2019, 76 patients with knee osteoarthritis who underwent high tibial osteotomy in the First Department of Joint Surgery of the Affiliated Hospital of Weifang Medical University were selected as the research subjects. The 76 patients were randomly divided into two groups (n=38). Tranexamic acid saline injection (1 g, 100 mL) was given intravenously 30 minutes before the operation in the trial group, and the same amount of saline was given intravenously in the control group. General perioperative data such as age, sex ratio, body mass index, hemoglobin, hematocrit, fibrinogen, prothrombin time, and activated partial prothrombin time were recorded in both groups. The two groups of patients were operated by the same group of physicians, and the internal fixation was made by the same company. The operation time, intraoperative blood loss and postoperative drainage, blood transfusion, hemoglobin and hematocrit at 1, 3, and 5 days after surgery, coagulation index at 3 days surgery, and venous thrombosis of the lower limbs at 5 days after surgery were recorded. Total blood loss, hidden and dominant blood loss were calculated.
RESULTS AND CONCLUSION: (1) The perioperative general information was not statistically significant between the two groups (P > 0.05). There was no significant difference in the operation time between the two groups (P > 0.05). (2) The total blood loss, hidden and dominant blood loss and postoperative drainage volume in the trial group were less than those in the control group (P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). There was a statistically significant difference in the maximum reduction in hemoglobin and the maximum reduction in hematocrit after surgery between the two groups (P < 0.05). (3) One case in the control group was treated with blood transfusion, accounting for 3%. There was no blood transfusion treatment in the trial group, and the difference between the two groups was not statistically significant (P > 0.05). (4) There was no statistically significant difference in fibrinogen, activated partial prothrombin time and prothrombin time between the two groups at 1, 2, and 3 days after surgery (P > 0.05). (5) One case of urinary tract infection occurred in the control group after high tibial osteotomy, and no other obvious complications occurred. At 5 days after the operation, the color Doppler ultrasound of the lower extremities was reexamined. No deep vein thrombosis of the lower extremities was found in the two groups (P > 0.05). (6) It is concluded that intravenous application of tranexamic acid before high tibial osteotomy in knee osteoarthritis patients can reduce the total blood loss during perioperative period, especially the hidden blood loss, and it will not increase the risk of deep venous thrombosis of the lower extremities.

Key words: knee, osteoarthritis, high tibial osteotomy, tranexamic acid, hemostasis, perioperative period

CLC Number:

Ma Zhen, Liang Da, Wu Xiaolin, Zhong Wei . Safety evaluation of tranexamic acid in reducing perioperative blood loss in high tibial osteotomy[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1847-1852.

Figures/Tables 7

References

[1] 张子琦,梁佳林,樊立宏,等.开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察[J].中国修复重建外科杂志, 2018, 32(8):997-1000.
[2] GENG D, YANG H, XU Y, et al.Treatment of unstable proximal femoral fractures: comparison of the PFNA and gamma 3. Orthopedics. 2010; 33(2):473-478.
[3] 刘志宏,张炅,何川,等. 活动平台全膝关节假体和单髁膝关节假体置换术后的步态对比分析[J]. 中华关节外科杂志(电子版), 2017,11(1):17-23.
[4] 叶晔,刘又文,李无阴,等.单髁置换治疗股骨外髁重度剥脱性骨软骨炎[J].中国矫形外科杂志,2020,28(9):837-840.
[5] 倪建龙,时志斌,樊立宏,等.胫骨高位截骨联合微骨折术治疗膝内侧间室骨关节炎[J].中华关节外科杂志(电子版),2020,14(1): 40-45.
[6] 徐奎帅,张益,申友亮,等.胫骨高位截骨术放置引流管与否对术后失血量及早期并发症发生的影响[J].中国骨与关节损伤杂志, 2020,35(6):581-584.
[7] 许宏,张少云,雷一霆,等.全膝关节置换术后多次静脉应用氨甲环酸的有效性及安全性[J].中国矫形外科杂志,2018,26(7):604-609.
[8] 张连方,朱锋,周军,等.氨甲环酸减少股骨粗隆间骨折PFNA围术期失血[J].中国矫形外科杂志, 2017, 25(24): 2248-2250.
[9] LI S, LU Q, GUO X, et al. Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case-Control Study. Orthop Surg. 2020;12(2):11-16.
[10] LIU KL, CHEN IH, WEN SH. Low dose tranexamic acid reduces blood transfusion rate after total knee arthroplasty: A population-based study in Taiwan. Formos Med Assoc. 2016;5:224-232.
[11] 许小志,谢学文.氨甲环酸不同给药时间对全髋关节置换术中及术后失血量的影响[J]. 中国现代药物应用, 2016,10(13):32-33.
[12] 李松林,卢群山,张蒙,等.静脉输注氨甲环酸对胫骨高位截骨术后患者失血量的影响[J]. 骨科临床与研究杂志,2019,4(6):343-348.
[13] NADLER SB, HIDALGO JU, BLOCH T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224-232.
[14] GROSS JB. Estimating Allowable Blood Loss: Corrected for Dilution. Anesthesiology. 1983;58(3):277-280.
[15] 张世峰,金群华.胫骨高位截骨术治疗膝内侧单间室骨关节炎的研究进展[J].中华老年骨科与康复电子杂志,2018,4(5) :312-316.
[16] 罗旺林,殷德雄,彭超,等.胫骨高位截骨与单髁置换治疗单室膝骨性关节炎的荟萃分析[J]. 中国矫形外科杂志,2018,26(9):814-820.

[17] SLATTERY C, KARK J, WAGNER T, et al. The Use of Tranexamic Acid to Reduce Surgical Blood Loss: A Review Basic Science, Subspecialty Studies, and The Evolution of Use in Spine Deformity Surgery. Clin Spine Surg. 2019;32(2):80-86.
[18] 严晓波,蔡伟康,林秾,等.氨甲环酸对膝关节保肢术围手术期出血影响的研究[J].中华骨科杂志,2020,40(15):1004-1010.
[19] 孙长鲛,杜瑞勇,吴厦,等.口服氨甲环酸和静脉氨甲环酸在全膝关节置换术中疗效对比的Meta分析[J].中国骨与关节杂志,2020, 9(7):508-515.
[20] 李辉, 马建兵, 陈信林, 等. 氨甲环酸降低股骨粗隆间骨折PFNA术后失血量的临床研究[J]. 实用骨科杂志, 2016, 22(11):973-975.
[21] 雷金来, 张斌飞, 庄岩,等. 氨甲环酸减少股骨粗隆间骨折PFNA内固定手术隐性失血的随机对照试验[J]. 中国骨与关节损伤杂志, 2018,33(12):1244-1246.
[22] 王金良,李哲,骆晓飞,等.氨甲环酸对初次全膝关节置换术后引流管拔除时机的影响[J].中华骨科杂志,2020,40(10):635-643.
[23] 蒋玮,胡孔足,桂斌捷,等. 氨甲环酸不同给药时间对减少全髋关节置换术失血的影响[J]. 创伤外科杂志,2020,22(4):284-287.
[24] 贾潇,王常德,雒永生,等. 单次及两次静脉滴注氨甲环酸对老年股骨转子间骨折患者围术期隐性失血和凝血功能的影响[J]. 中国老年学杂志,2020,40(8):1640-1643.
[25] 周晓强,虞宵,荆翔,等.静脉应用氨甲环酸联合局部灌注含氨甲环酸混合镇痛药物在单髁置换术中的应用[J].中国骨与关节损伤杂志,2020,35(4):401-404.
[26] 曹恒,刘明廷,王建明,等.氨甲环酸对膝关节内侧单间室置换术后失血量的影响[J].中国矫形外科杂志,2018,26(7):610-614.
[27] KIM KI, KIM HJ, KIM GB, et al. Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy. Orthop Traumatol Surg Res. 2018;104(7):1003-1007.
[28] 张剑锋,杨伟臻,李文琴,等.静脉联合关节腔内应用氨甲环酸减少单侧全膝关节置换术后出血的疗效观察[J].中国现代医生, 2016,54(33):64-67.
[29] 雷一霆,谢锦伟,曹国瑞,等.THA围手术期多次应用氨甲环酸的效果[J].中国矫形外科杂志,2017,25(23):2134-2138.
[30] SUH DW, KYUNG BS, HAN SB, et al. Efficacy of tranexamic acid for hemostasis in patients undergoing high tibial osteotomy. J Knee Surg. 2018; 31: 50-55.
[31] PALANISAMY JV, DAS S, MOON KH, et al. Intravenous tranexamic acid reduces postoperative blood loss after high tibial osteotomy. Clin Orthop Relat Res. 2018;476:2148-2154.