Study On The Hemostatic Effect And Safety Of Different Usages Of Tranexamic Acid In Hip And Knee Arthroplasty

Objectives:The incidence of degenerative diseases of the hip and knee joints is increasing with the aging of the population.Artificial joint replacement surgery has brought good news to such patients.Total hip and total knee replacement can effectively relieve the pain of patients and improve the quality of life of patients.However,total hip and total knee arthroplasty usually lose a lot of blood,and safe and effective reduction of perioperative blood loss is essential for patient recovery.Hemostatic drugs have always been recommended to control blood loss.Among them,tranexamic acid is the most widely used.Tranexamic acid has been widely used in orthopedic surgery,but its best use in total hip and total knee arthroplasty is still unclear.Postoperative complications such as deep vein thrombosis and pulmonary embolism in the lower extremities are still unclear.There is a huge controversy.This study aims to investigate the hemostatic effect and safety of different usages of tranexamic acid in total hip and total knee arthroplasty.Methods:This study retrospectively collected clinical data of patients undergoing unilateral total hip replacement and unilateral total knee replacement in the Second Affiliated Hospital of Kunming Medical University from January 2018 to November 2020.According to the different usage methods of tranexamic acid(TXA),patients undergoing two types of surgery were divided into a combined group(preoperative intravenous drip 15mg/kg combined with intraoperative intra-articular injection of 1g TXA)and intravenous group(preoperative intravenous drip).Injection 15mg/kg TXA),local group(intraoperative intra-articular injection of 1g TXA)and control group(without TXA).Comparing the general data,total perioperative blood loss,intraoperative blood loss,postoperative blood loss,hidden blood loss,blood transfusion rate and hemoglobin,hematocrit,coagulation index,etc.of patients in different groups during the two operations.The changes of indicators and the occurrence of complications such as deep vein thrombosis(DVT)and pulmonary embolism in the lower extremities will be further explored for the hemostatic efficacy and safety of different uses of TXA in hip and knee arthroplasty.Results:A total of 405 patients met the inclusion criteria for this project,of which 240 patients underwent total hip replacement,60 in the combined group,60 in the intravenous group,60 in the local group,and 60 in the control group.The average perioperative total blood loss of the four groups was 520.50 ± 168.60ml,604.70 ±186.50ml,592.70±221.50ml,749.00±207.90ml,and the average intraoperative blood loss was 223.00±92.49ml,320.80±224.40ml,328.30±281.70ml,367.70 ±230.80ml,the blood transfusion rates were 1.67%,5%,3.33%,20%,respectively.Compared with the intravenous group,the local group,and the control group,the combined group had an average total perioperative blood loss and intraoperative blood loss The amount of blood loss was significantly reduced,and the difference was statistically significant(P<0.05);compared with the control group,the combined group,intravenous group,and local group had significant perioperative total blood loss and blood transfusion rate(P<0.05).0.001);Compared with the control group,the combined group had significantly less hidden blood loss,with statistical differences(P<0.05);there was no statistical difference in postoperative blood loss between the groups of patients;the general information and coagulation indexes of the four groups There were no statistically significant differences in the incidence of complications such as DVT,DVT and pulmonary embolism.There were 165 patients underwent total knee arthroplasty,42 in the combined group,41 in the intravenous group,41 in the local group,and 41 in the control group.The average perioperative total blood loss of the four groups of patients was 431.00±147.10ml,506.60 ±153.80ml,520.70±190.90ml,526.10±179.60ml,and the average intraoperative blood loss was 162.60±49.34ml,196.10±100.80ml,191.70,respectively.±82.06ml,247.80±145.60ml,the blood transfusion rates were 0%,4.88%,2.44%,4..88%,respectively.Compared with the intravenous group,the local group,and the control group,the combined group had a significant perioperative total blood loss Reduced,the difference was statistically significant(P<0.05);Compared with the control group,the average blood loss in the combined group was significantly different(P<0.001);the postoperative blood loss and hidden blood loss were compared in each group There was no statistically significant difference(P>0.05);there was no statistically significant difference in the general information,blood transfusion rate,coagulation index,DVT,and pulmonary embolism among the four groups of patients.Conclusions:1.In total hip arthroplasty,a single vein or a single topical application of TXA and a vein combined with topical TXA can safely and effectively reduce perioperative blood loss and blood transfusion rate;intravenous combined with topical TXA has the most significant hemostatic effect,And will not increase the incidence of complications such as DVT and pulmonary embolism.2.In total knee arthroplasty,single intravenous or single topical application of TXA cannot reduce perioperative blood loss and blood transfusion rate;intravenous combined local application of TXA can safely and effectively reduce perioperative blood loss,but it is effective for perioperative blood transfusion Rate has no effect.