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

Year 2019, , 39 - 43, 27.01.2019

Seher Orbay Yaşlı , Zeynep Tosun Mehmet Halıcı Selda Kahraman Kayaaltı

https://doi.org/10.28982/josam.441116

Abstract

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.

Keywords

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

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