نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشگاه علوم پزشکی جندی شاپور اهواز

2 دانشگاه علوم‌پزشکی جندی شاپور اهواز

چکیده

چکیده
مقدمه: آرتروپلاستی زانو، TKA (Total Knee Arthroplasty) یک درمان مؤثر است که در مرحلة آخر آرتروز و سایر بیماری‌های زانو برای تسکین درد و بهبود کیفیت زندگی انجام می‌شود. در حالی که TKA مزایایی همچون کاهش درد و عملکرد بهتر زانو را دارد، اما ممکن است خطرهایی مانند خونریزی، حوادث ترومبوآمبولیک، عفونت و نیاز به اقدامات جراحی اضافی نیز در پی داشته باشد. ترانکسامیک اسید، TXA (Tranexamic Acid) در کاهش خونریزی بعد از انجام چنین عمل‌های جراحی بزرگی مؤثر است. در مطالعات فراوان تأیید می‌شود که تجویز وریدی، IV (Intravenous) و داخل مفصلی، IA (Intra-Articular) ترانکسامیک اسید  باعث کاهش خونریزی در آرتروپلاستی زانو  می‌شود.
روش‌ها و مواد: این یک مطالعه مقطعی گذشته‌نگر بر روی ۱۵۲ بیمار زن و مرد ۴۵ تا ۸۵ ساله است که عمل تعویض مفصل زانو برای آنها انجام شد. بیماران به دو گروه تقسیم شدند. گروه آزمایش، ۷۲ بیمار که در جریان جراحی داروی ترانکسامیک اسید دریافت کردند و گروه شاهد، ۸۰ بیمار که که در جریان جراحی این دارو را دریافت نکردند. میزان هموگلوبین، تعداد واحد خون تزریق شده، مدت زمان بستری دربیمارستان، نمره‌بندی درد بر اساس مقیاس دیداری، VAS Score
(Visual Analogue Scale Score)، اندازة دامنة حرکتی زانو و حوادث ترومبوآمبولیک ثبت و بین دو گروه مقایسه شد.
نتایج: مقایسة نتایج نشان داد میزان کاهش هموگلوبین، اندازة هموگلوبین پس از عمل، تعداد واحد خون تزریق شده و مدت زمان بستری دربیمارستان بین دو گروه آزمایش و شاهد تفاوت معنی‌داری دارد، در حالی که مقایسه میزان هموگلوبین قبل از عمل، اندازة دامنة حرکت زانو، نمرة VAS برای اندازه‌گیری شدت درد و حوادث ترومبوآمبولیک تفاوت معنی‌داری نشان نداد.
نتیجه‌گیری: تجویز ترانکسامیک اسید می‌تواند عوارض جراحی تعویض مفصل زانو به دلیل خونریزی و همچنین نیاز به انتقال خون را کاهش دهد. علاوه بر این، تجویز ترانکسامیک اسید می‌تواند طول مدت بستری در بیمارستان را پس از جراحی تعویض مفصل زانو کاهش دهد که در نتیجه هزینه‌های بستری بیماران نیز به میزان قابل توجهی کاهش می‌یابد.
 

کلیدواژه‌ها

عنوان مقاله [English]

The effect of Tranexamic Acid on Blood Loss and Hospital-Stay after Knee Replacement Surgery

چکیده [English]

Abstract
Background: Total knee arthroplasty (TKA) is widely used as an effective treatment for end-stage osteoarthritis and other knee diseases to relieve pain and improve quality of life. While the benefits of TKA are reduced pain and an improved function there are also risks, such as hemorrhage, thromboembolic events, infection and the need for additional surgical procedures. Tranexamic acid (TXA) is effective in reduction of hemorrhage after such major surgical procedure. Abundant literature confirms that intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) reduces blood loss in total knee arthroplasty (TKA). 
Methods and Material:The study is a retrospective cross-sectional study of 152 male and female patients aged 45 to 85 years who underwent Total knee replacement. They were divided into two groups.72 patients received tranexamic acid during the operation and 80 patients did not.
Hemoglobin, transfused packed cell, hospital time, Visual analogue pain scale, Knee range of motion and cardiovascular accident were determined and compared between the two groups.
Results: Comparing the result of hemoglobin drop, post op hemoglobin, transfused packed cell and hospital stay time showed significant difference between experimental and control group when pre op hemoglobin, range of motion, VAS score for pain measurement and cardiovascular effects were not significantly different.
Conclusions: We found that the administration of tranexamic acid can reduce the complications of knee replacement surgery due to bleeding, as well as decreasing the need for blood transfusion. In addition, the administration of tranexamic acid can reduce the length of hospital stay after knee replacement surgery; that in turn significantly reduces the cost of hospitalization.
 
 

کلیدواژه‌ها [English]

  • Keywords: Knee Arthroplasty
  • joint Replacement
  • Surgical blood loss
  • Blood transfusion
  • Tranexamic acid
  1. Diduch D R, Insall J N, Scott W N. Active patients, long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997;79(4):575-82.
  2. Berman AT, Geissele AE, Bosacco SJ. Blood loss with total knee arthroplasty. Clin Orthop Relat Res. 1988;(234):137-8.
  3. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014; 22(6):361-71.
  4. Liu D, Dan M, Martinez Martos S, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Relat Res. 2016;28(3):179-87.
  5. Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am. 2010;92(15):2503-13
  6. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5. https://doi.org/10.2106/JBJS.F.00222.
  7. Rothbauer F, Zerwes U. Bleß H. Kip M Weißbuch Gelenkersatz. 2017:17–41.
    https://doi.org/10.1007/978-3-662-53260-7.
  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). J Bone Joint Surg Am. 2013;95(21):1961–8.
    https://doi.org/10.2106/JBJS.L.00907.
  9. Good L, Peterson E. Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. 2003; https://doi.org/10.1093/bja/aeg.
  10. Hiippala S, Strid L, Wennerstrand M, et al. Tranexamic acid (Cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty. Br J Anaesth. 1995;74(5):534–7.
  11. Jansen AJ, Andreica S, Claeys M, D’Haese J, Camu F, Jochmans K. Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty. Br J Anaesth. 1999. https://doi.org/10.1093/bja/83.4.596.
  12. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee: In; 2000. https://doi.org/10.1016/S0968-0160(00)00047-8.
  13. Bierbaum B E, Hill C, Callaghan J J et al., “An analysis of blood management in patients having a total hip or knee arthroplasty,” J Bone Joint Surg Am, vol. 81, no. 1, pp. 2–10, 1999.

 

  1. Bong M R, Patel V, Chang E, Issack P S, Hebert R, and Di Cesare P E, “Risks associated with blood transfusion after total knee arthroplasty. The Journal of Arthroplasty. 2004; 19(3): 281–287.
  2. Goodnough L T, Verbrugge D, Marcus R E. The relationship between hematocrit, blood lost, and blood transfused in total knee replacement. Implications for postoperative blood salvage and reinfusion. American Journal of Knee Surgery.1995; 8(3): 83–87.
  3. Keating E M, Meding J B, Faris P M, Ritter M A, Predictors of transfusion risk in elective knee surgery. Clinical Orthopaedics and Related Research.1998; 357: 50–59.
  4. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Timing of the administration of tranexamic acid for maximum reduction in blood loss in arthroplasty of the knee. J Bone Joint Surg_B. 2001; 83(5): 702–705.
  5. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014 ; 22(6):361-71.
  6. Liu D, Dan M, Martinez Martos S, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Relat Res. 2016;28(3):179-87.
  7. Volpato SE, Ferreira JS, Ferreira VL, Ferreira DC. Transfusão de concentrado de hemácias em unidade de terapia intensiva. Rev Bras Hematol Hemoter. 2005 ;27:179-82.
  8. Kumar N, Saleh J, Gardiner E, Devadoss VG, Howell FR. Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss. J Arthroplasty. 2000;15(7):947-9
  9. Juelsgaard P, Larsen UT, Sørensen JV, Madsen F, Søballe K. Hypotensive epidural anesthesia in total knee replacement without tourniquet: reduced blood loss and transfusion. Reg Anesth Pain Med. 2001 ;26(2):105-10.
  10. Gibbons CE, Solan MC, Ricketts DM, Patterson M. Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop. 2001 ;25(4):250-2.
  11. Roy N, Smith M, Anwar M, Elsworth C. Delayed release of drain in total knee replacement reduces blood loss. A prospective randomised study. Acta Orthop Belg. 2006 ;72(1):34-8.
  12. Wang GJ, Hungerford DS, Savory CG, Rosenberg AG, Mont MA, Burks SG, et al. Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty: a brief note on a randomized prospective trial. J Bone Joint Surg Am. 2001 ;83(10):1503-5.
  13. Sadigurski D, Andion D, Boureau P, Ferreira MC, Carneiro RJF, Colavolpe PO. Efeito do ácido tranexâmico na prevenção do sangramento na artroplastia total de joelho. Acta Ortop Bras. 2016 ;24(3):131-6.
  14. Gasparini G, Papaleo P, Pola P, Cerciello S, Pola E, Fabbriciani C. Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty. Int Orthop. 2006 ;30(4):253-6.
  15. Gardner MJ, Demetrakopoulos D, Klepchick PR, Mooar PA. The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion. Int Orthop. 2007 ;31(3):309-13.
  16. . Benoni Gn, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty, J Bone Joint Surg_B. 1996; 78-B(no. 3): 434–440.
  17. Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2012; 94(13): 1153–1159.
  18. Georgiadis A G, Muh S J, Silverton C D, Weir R M, Laker MW. A prospective double-blind placebo controlled trial of topical tranexamic acid in total knee arthroplasty. The Journal of Arthroplasty. 2013; 28(8): 78–82.
  19. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2014; 29(8):1528-31.
  20. Mosaffa F, Kazemi S M, Kaffashi M et al. The Effect of Pre-operative Tranexamic Acid on Blooding Prevention in Non-Cemented Hip Arthroplasty. Iranian Journal of Orthopaedic Surgery. 2009; 28:114-20.
  21. Sarzaeem M M, Kazemian Gh, Manafi Rasi A, et al. Efficacy of Three Methods of Tranexamic Acid Administration in Reduction of Blood Loss Following Knee Arthroplasty. Iranian Journal of Orthopaedic Surgery. 2013;11(42):1-6.
  22. Marra F, Rosso F, Brruzone M,  Bonazia D, Dettoni F,  Rossi R. Use of tranexamic acid in total knee arthroplasty. 2016 ; 4(4): 202–213.
  23. Fernandes Guerreiro J,  Badaro B,   Martines Balbino J,  Danieli M,  Oliveira Queiroz A,  Cataneo D. Application of Tranexamic Acid in Total Knee Arthroplasty – Prospective Randomized Trial. Open Orthop J. 2017 ;11: 1049–1057.
  24. Tille E, Mysliwietz J, Beyer F, Postler A, Lützner J. Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty. BMC Musculoskelet Disord. 2019; 20(1):341.
  25. Guo P, He Z, Wang Y, Gao F, Sun W, Guo W. et al. Efficacy and safety of oral tranexamic acid in total knee arthroplasty. Medicine (Baltimore). 2018; 97(18):587.