Total kalça protez ameliyatlarında yüksek doz traneksamik asitin etkileri: Prospektif, çift-kör, randomize kontrollü çalışma

Öz

Amaç: Farklı çalışmalar total kalça protezi ameliyatlarında transfüzyon oranını azaltmak için traneksamik asit (TA) kullanımını desteklemektedir. Bu çalışmada total kalça protezi ameliyatında yüksek doz TA'nın etkilerinin araştırılması amaçlanmıştır.

Yöntemler: Bu çalışma için American Society of Anesthesiologist(ASA) sınıf I-III 60 yetişkin hasta, grup TA ve grup kontrol (C) olarak 2 gruba ayrıldı. TA grubuna 50 mg / kg’dan traneksamik asit, kontrol grubu (C grubu) hastalarına ise 100 cc normal salin (NS) uygulandı. Tüm olgularda hemoglobin(Hgb), hematocrit(Hct), trombosit sayısı, protrombin zamanı(PT), parsiyel tromboplastin zamanı(PTT), fibrinojen, D-dimer, kan üre azotu(BUN), kreatinin ve sistatin-c değerlerinin çalışılması için hastalardan operasyondan 24 saat önce ve sonra kan örnekleri alındı. İntraoperatif kanama miktarları, transfüze edilen eritrosit süspansiyonu (PRBC) sayısı kaydedildi.

Bulgular: Grup TA’da kan kaybı miktarı verilmiş olan eritrosit süspansiyonu sayısı grup C’ye göre istatistiksel olarak anlamlı düşük bulundu. Taburculuktaki hemoglobin değerleri grup TA’da grup C’ye göre istatistiksel olarak anlamlı yüksek bulundu. TA grubunun postoperatif sistatin-c değerleri preoperatif periyottaki değerlerinden istatistiksel olarak anlamlı düşük bulundu. TA grubunun hastanede kalış süreleri istatistiksel anlamlı olarak düşük bulundu.

Sonuç: Total kalça protezi ameliyatlarında insizyondan önce uygulanan 50 mg/kg traneksamik asit intraoperatif kan kaybı miktarını ve verilen eritrosit süspansiyon sayısını azaltır. Aynı zamanda bu yaklaşımla taburculukta daha yüksek hemoglobin değerleri sağlanır. Bu prosedür böbrek fonksiyonlarını etkilemediği gibi hastanede kalış sürelerinin de kısalmasına neden olur.

Anahtar Kelimeler

• Traneksamik asit,Total kalça protezi,Kan transfüzyonu

Effects of high-dose tranexamic acid in total hip replacement: A prospective, double-blind, randomized controlled study

Abstract

Aim: Different studies support the use of tranexamic acid (TA) to decrease the rate of transfusions in total hip replacement. This study aimed to investigate the effects of high-dose TA in total hip replacement.

Methods: Sixty American Society of Anesthesiologist (ASA) class I-III 60 adult patients were randomly assigned into 2 groups as group TA and group control (C) for this study. While, TA was administered at dose of 50 mg/kg to group TA, the group C received 100 cc normal saline (NS). In all subjects, blood samples were taken pre-surgery and 24 hours after the operation in order to study hemoglobin (Hgb), hematocrit (Hct), platelet count, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, D-dimer, blood urea nitrogen (BUN), creatinine, and cystatin-c. The amount of intraoperative bleeding and number of given packed of red blood cell (PRBCs) were recorded.

Results: The amount of blood loss and number of PRBCs given were significantly lower, and Hgb values at discharge were significantly higher in group TA compared with group C. In group TA postoperative cystatin-c levels, compared with the preoperative period, were significantly low. The length of hospital stay was significantly short in group TA.

Conclusion: TA was given intravenously before incision reduces intraoperative blood loss and the use of PRBCs in total hip replacement. This approach also provided higher Hgb values at discharge. The provision of TA shortened length of hospital stay and did not negatively affect renal function.

Keywords

• Tranexamic acid
• Total hip replacement
• Blood transfusion

References

1. 1. Gill JB, Rosenstein A. The use of antifibrinolytic agents in total hip arthroplasty: a meta-analysis. J Arthroplasty. 2006;21:869-73.
2. 2. John R Hess, Seppo Hiippala. Optimizing the use of blood products in trauma care. Crit Care. 2005; 9: 10-4.
3. 3. Jansen AJ, Andreica S, Claeys M, D'Haese J, Camu F, Jochmans KUse of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty.Br J Anaesth. 1999;83:596-601.
4. 4. Zufferey P, Merquiol F, Laporte S et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006;105:1034-46.
5. 5. Henry DA, Carless PA, Moxey AJ et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;19:1. CD001886
6. 6. Yamasaki S, Masuhara K, Fuji T. Tranexamic acid reduces blood loss after cementless total hip arthroplasty-prospective randomized study in 40 cases. Int Orthop. 2004;28:69-73.
7. 7. Toy PT, Kaplan EB, McVay PA, Lee SJ, Strauss RG, Stehling LC. Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group. Transfusion. 1992 Jan;32:63-7.
8. 8. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S.Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006 Nov;105:1034-46.

9. 9. Claeys M, Vermeersch N, Haentjens P. Reduction of blood loss with tranexamic acid in primary total hip replacement surgery. Acta chir Belg. 2007;107:397-401.
10. 10. Benoni G, Fredin H, Knebel R, Nilsson P. Blood conservation with tranexamic acid in total hip arthroplasty: a randomized, double-blind study in 40 primary operations. Acta Orthop Scand. 2001;72:442-8.
11. 11. Husted H, Blond L, Sonne-Holm S, et al. Tranexamic acid reduces blood loss and blood transfusions in primary total hip arthroplasty A prospective randomized double-blind study in 40 patients. Acta Orthop Scand. 2003;74:665-9.
12. 12. Rajesparan K, Biant L, Ahmad M, Field R. The effect of an intravenous bolus of tranexamic acid on blood loss in total hip replacement. J Bone Joint Surg Br. 2009;91:776-83.
13. 13. Karski JM, Dowd NP, Joiner R, Carroll J, Peniston C, Bailey K, Glynn MF, Teasdale SJ, Cheng DC: The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C). J Cardiothorac Vasc Anesth 1998;12:642.
14. 14. Krishnamurti C, Vukelja SJ, Alving BM. Inhibitory effects of lysine analogues on t-PA induced whole blood clot lysis. Thromb Res. 1994;73:419-30.
15. 15. Lemay E, Guay J, Cote C, Roy A. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anesth. 2004;51:31-7.
16. 16. Benoni G, Lethagen S, Nilsson P, Fredin H. Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthop Scand. 2000;71:250-4.
17. 17. Andersson L, Nilsoon IM, Colleen S, et al. Role of urokinase and tissue activator in sustaining bleeding and the management thereof with EACA and AMCA. Ann N Y Acad Sci. 1968;146:642-58.
18. 18. Garneti N, Field J. Bone bleeding during total hip arthroplasty after administration of tranexamic acid. J Arthroplasty. 2004;19:488-92.
19. 19. Eriksson BI, Hultman E, Martinell S, et al. Regional fibrinolysis following total hip replacement. Thromb Res. 1991;62:441-7.
20. 20. Ekbäck G, Axelsson K, Ryttberg L, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000;91:1124-30.
21. 21. Lee YC, Park SJ, Kim JS, Cho CH. Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement. J Clin Anesth. 2013;25:393-8.
22. 22. Imai N, Dohmae Y, Suda K, et al. Tranexamic Acid for Reduction of Blood Loss During Total Hip Arthroplasty. J Arthroplasty. 2012;27:1838-43.
23. 23. Ho KW, Ismail H. Use of intravenous tranexamic acid to reduce allogenic blood transfusion in total hip and knee arthroplasty: meta-analysis. Anaesth Intensive Care. 2003;31:529-37.
24. 24. Lindoff C, Rybo G, Astedt B. Treatment with tranexamic acid during pregnancy, and the risk of thrombo-embolic complications. Thromb Haemost. 1993;70:238-40.
25. 25. Sukeik M, Alshryda S, Haddad FS, et al. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011;93:39-46.
26. 26. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999;57:1005-32.
27. 27. Morgan PD, Brown RS, Thwaites BK. Tranexamic acid and aprotinin reduce postoperative bleeding and transfusions during primary coronary revascularization. Anesth Analg. 1998;87:258-65.
28. 28. Hourlier H, Fennema P. Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial. Hip Int. 2014;24:63-8.
29. 29. Yong Z, Pei X, Zhu B, Yuan H, Zhao W. Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials. Sci Rep. 2017;7:41012.