Abstract
Purpose
This prospective randomized double-blind trial evaluates the efficacy of tranexamic acid (TA) to decrease blood losses and red blood cell transfusions in patients undergoing primary unilateral total hip replacement (THR).
Methods
Forty ASA class I to III patients received eitheriv TA 10 mg· kg−1 bolus before surgery plus a l mg · kg−1 · hr−1 infusion until wound closure (Group TA) or a placebo (Group P). Red blood cell transfusions were administered according to a standardized protocol.
Results
One patient of Group P was excluded because of an erroneous diagnosis at enrollment. Total measured blood losses (Group TA: 1308 ± 462 mLvs Group P: 1469 ± 405 mL), preoperative hemoglobin levels (Group TA: 130.4 ± 12.5 g · L−1 vs Group P: 131.4 ± 12.8vs g · L−1), and seven-day postoperative hemoglobin values (Group TA: 97.8 ± 11.8 g · L−1 vs Group P: 102.9 ± 12.2 g · L−1) were similar. Autologous whole blood was available in five patients of Group P and seven patients of Group TA. Fewer patients in Group TA required red blood cells (Group TA: 6/20 vs Group P: 13/19;P = 0.026) and allogenic red blood cell transfusions (Group TA: 0/20 vs Group P: 8/19;P = 0.0012). The median number of transfused unit per patient was also significantly less in patients of Group TA (0 unit) than in Group P (2 units;P = 0.03).
Conclusion
TA did not change measured blood losses but reduced red blood cell transfusion requirements in patients undergoing primary unilateral THR.
Résumé
Objectif
Cette étude prospective, randomisée et en doubie aveugle évaiue l’efficacité de l’acide tranexamique (AT) pour réduire le saignement et les transfusions sanguines des patients subissant une arthroplastie primaire unilatérale de la hanche.
Méthode
Quarante patients ASA I à III ont été divisés en deux groupes et ont reçu : 10 mg · kg−1 d’AT à l’induction plus une perfusion de 1 mg · kg−1· h−1 jusqu’à la fermeture de la plaie (Groupe AT) ou un placebo (Groupe P). Les transfusions sanguines étaient administrées selon un protocole prédéterminé.
Résultats
Un patient du Groupe P a été exclu de l’analyse (diagnostic erroné). Les groupes sont comparables pour les pertes sanguines totales mesurées (1308 ± 462 vs 1469 ± 405 mL), l’hémoglobine préopératoire (130,4 ± 12,5 vs 131,4 ± 12,8. g · L−1) et postopératoire au jour sept (97,8 ± 11,8 vs 102,9 ± 12,2 g · L−1) (groupes AT et P respectivement). Le sang autologue était disponible pour cinq patients du Groupe P et sept du Groupe AT. L’AT réduit le nombre de patients transfusés (6/20 vs 13/19; P = 0,026), l’administration de sang homologue (0/20 vs 8/19; P = 0,0012) et le nombre d’unités transfusées par patient (0 vs 2; P = 0,03).
Conclusion
L’AT ne réduit pas les pertes sanguines mesurées mais réduit les besoins en transfusions sanguines et l’administration de sang homologue chez les patients subissant une arthroplastie de la hanche.
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This study was funded by a grant from the “Fonds de développement du département d’Anesthésiologie de l’université de Montréal”.
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Lemay, E., Guay, J., Côté, C. et al. Tranexamic acid reduces the need for allogenic red blood cell transfusions in patients undergoing total hip replacement. Can J Anesth 51, 31–37 (2004). https://doi.org/10.1007/BF03018543
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DOI: https://doi.org/10.1007/BF03018543