Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Tranexamic Acid Reduces Postoperative Blood Loss in Reverse Total Shoulder Arthroplasty

역행성 견관절 전치환술에서 트라넥삼산의 출혈 및 수혈 감소 효과

  • Park, Kee Young (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Kim, In Bo (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Kim, Eun Yeol (Department of Orthopaedic Surgery, Busan Bumin Hospital) ;
  • Lee, Kwang Suk (Department of Orthopaedic Surgery, Busan Bumin Hospital)
  • Received : 2020.12.11
  • Accepted : 2021.02.04
  • Published : 2021.10.30
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Abstract

Purpose: Tranexamic acid (TXA) can reduce perioperative blood loss and the frequency of blood transfusions in lower extremity surgery. On the other hand, the effects of TXA on reverse total shoulder arthroplasty (rTSA) remain undetermined. This study evaluated the efficacy of TXA on perioperative blood loss, transfusion requirements, and the change in the hemotologic index. Materials and Methods: This study evaluated patients who underwent rTSA from September 2009 to July 2020. The patients were classified into two groups. The TXA group were administered TXA intravenously and topical TXA during surgery. The non-TXA group was not administered TXA. The quantity of hemovac drainage, which represented the postoperative blood loss, transfusion requirements, and postoperative change in hemoglobin and hematocrit level, were recorded. Results: The TXA and non-TXA groups consisted of 93 and 84 patients, respectively. The preoperative demographics showed no significant differences in age (72.0±7.0 vs. 71.5±5.8, p=0.656), sex (male:female, 28:65 vs. 23:61, p=0.689) and the prevalence of hypertension and diabetes (hypertension:diabetes:both, 36:3:13 vs. 32:3:8, p=0.806) between the two groups. There were significant differences in the requirements of transfusion (0 vs. 9, p=0.001), hemovac drainage at the 1st (98.8±61.2 ml vs. 162.7±98.8 ml, p<0.001), the 2nd postoperative day (73.8±48.4 ml vs. 91.5±54.5 ml, p=0.024), hemoglobin level at the 1st (11.7±1.2 g/dl vs. 11.2±1.4 g/dl, p=0.048), 3rd (10.9±1.2 g/dl vs. 10.2±1.2 g/dl, p<0.001), and 6th (11.2±1.3 g/dl vs. 10.7±1.3 g/dl, p=0.020) postoperative day, and the hematocrit level at the 1st (35.0%±3.6% vs. 32.5%±3.8%, p=0.001), 3rd (32.3%±5.0% vs. 29.8%±3.6%, p<0.001), and 6th (33.5%±3.8% vs. 31.5%±3.7%, p<0.001) postoperative day between the two groups. Conclusion: Intravenous and topical intra-articular TXA can reduce the transfusion requirement and blood loss in rTSA.

목적: 트라넥삼산(tranexamic acid, TXA)은 하지 수술에서 출혈과 수혈 빈도를 줄이는 것으로 알려졌다. 본 연구에서는 역행성 견관절 전치환술 시에 출혈 및 수혈 요구에 대한 TXA의 효과를 평가하고자 하였다. 대상 및 방법: 2009년 9월부터 2020년 7월까지 역행성 견관절 전치환술을 시행한 환자를 평가하였다. 수술 중 정맥로와 관절강 내 도포를 시행한 군은 TXA 사용군, 시행하지 않은 군은 TXA 미사용군으로 분류하였다. 술 후 출혈량을 나타내는 배액관 배액량과 수혈 여부, 술 후 혈색소와 적혈구 용적률 수치를 분석하였다. 결과: TXA 사용군과 TXA 미사용군 간 연령(72.0±7.0 vs. 71.5±5.8, p=0.656) 및 남, 녀 성별 비율(28:65 vs. 23:61, p=0.689)은 유의한 차이가 없었다. 또한 고혈압, 당뇨병, 두 질환 모두를 가진 환자의 유병률(36:3:13 vs. 32:3:8, p=0.806)은 양 군 간 유의한 차이가 없었다. 수혈 기준에 따라 수혈을 시행한 수혈 환자 수(0 vs. 9, p=0.001)는 TXA 사용군에서 없었으며 TXA 미사용군에서 유의하게 더 많았다. 수술 1일째(98.8±61.2 ml vs. 162.7±98.8 ml, p<0.001) 및 제거 당시 배액관 배액량(73.8±48.4 ml vs. 91.5±54.5 ml, p=0.024)은 둘 다 TXA 사용군에서 유의하게 더 적었다. 수술 전 측정한 혈색소 수치(13.2±1.4 vs. 13.3±1.5, p=0.374)와 적혈구 용적률 수치(39.5±3.9 vs. 39.6±4.7, p=0.946)에서 양 군 간 유의한 차이가 없었다. 수술 1일째(11.7±1.2 g/dl vs. 11.2±1.4 g/dl, p=0.048), 3일째(10.9±1.2 g/dl vs. 10.2±1.2 g/dl, p<0.001), 6일째 혈색소(11.2±1.3 g/dl vs. 10.7±1.3 g/dl, p=0.020)는 TXA 사용군에서 유의하게 높았다. 수술 1일째(35.0%±3.6% vs. 32.5%±3.8%, p=0.001), 3일째(32.3% ±5.0% vs. 29.8%±3.6%, p<0.001), 6일째 적혈구 용적률 수치(33.5%±3.8% vs. 31.5%±3.7%, p<0.001)에서도 TXA 사용군에서 유의하게 높았다. 결론: 역행성 견관절 전치환술 시행 시 정맥로와 관절강 내 국소도포를 이용한 TXA의 사용은 수술 후 수혈의 필요성과 출혈량을 줄일 수 있다.

Keywords

References

  1. Kim DH, Lee GC, Lee SH, Pak CH, Park SH, Jung S. Comparison of blood loss between neutral drainage with tranexamic acid and negative pressure drainage without tranexamic acid following primary total knee arthroplasty. Knee Surg Relat Res. 2016;28:194-200. https://doi.org/10.5792/ksrr.2016.28.3.194
  2. Zohar E, Ellis M, Ifrach N, Stern A, Sapir O, Fredman B. The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement. Anesth Analg. 2004;99:1679-83, table of contents. https://doi.org/10.1213/01.ANE.0000136770.75805.19
  3. Yamasaki S, Masuhara K, Fuji T. Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. J Bone Joint Surg Am. 2005;87:766-70. https://doi.org/10.2106/00004623-200504000-00011
  4. Orpen NM, Little C, Walker G, Crawfurd EJ. Tranexamic acid reduces early post-operative blood loss after total knee arthroplasty: a prospective randomised controlled trial of 29 patients. Knee. 2006;13:106-10. https://doi.org/10.1016/j.knee.2005.11.001
  5. Ishida K, Tsumura N, Kitagawa A, et al. Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty. Int Orthop. 2011;35:1639-45. https://doi.org/10.1007/s00264-010-1205-3
  6. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93:2249-54. https://doi.org/10.2106/JBJS.J.01994
  7. Erickson BJ, Bohl DD, Cole BJ, et al. Reverse total shoulder arthroplasty: indications and techniques across the world. Am J Orthop (Belle Mead NJ). Published online September 26, 2018; doi:10.12788/ajo.2018.007.
  8. Jain NB, Yamaguchi K. The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23:1905-12. https://doi.org/10.1016/j.jse.2014.06.055
  9. Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med. 2009;361:787-94. https://doi.org/10.1056/NEJMcp0905029
  10. Anthony CA, Westermann RW, Gao Y, Pugely AJ, Wolf BR, Hettrich CM. What are risk factors for 30-day morbidity and transfusion in total shoulder arthroplasty? A review of 1922 cases. Clin Orthop Relat Res. 2015;473:2099-105. https://doi.org/10.1007/s11999-014-4107-7
  11. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198-208. https://doi.org/10.1097/00000542-200607000-00030
  12. Kuo LT, Hsu WH, Chi CC, Yoo JC. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19:60. https://doi.org/10.1186/s12891-018-1972-3
  13. 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;94:1153-9. https://doi.org/10.2106/JBJS.K.00873
  14. Yu BF, Yang GJ, Li Q, Liu LL. Tranexamic acid decreases blood loss in shoulder arthroplasty: a meta-analysis. Medicine (Baltimore). 2017;96:e7762. https://doi.org/10.1097/MD.0000000000007762
  15. Vara AD, Koueiter DM, Pinkas DE, Gowda A, Wiater BP, Wiater JM. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial. J Shoulder Elbow Surg. 2017;26:1383-9. https://doi.org/10.1016/j.jse.2017.01.005
  16. Yoon JY, Park JH, Kim YS, Shin SJ, Yoo JC, Oh JH. Effect of tranexamic acid on blood loss after reverse total shoulder arthroplasty according to the administration method: a prospective, multicenter, randomized, controlled study. J Shoulder Elbow Surg. 2020;29:1087-95. https://doi.org/10.1016/j.jse.2020.02.013
  17. Lin SY, Chen CH, Fu YC, Huang PJ, Chang JK, Huang HT. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty. 2015;30:776-80. https://doi.org/10.1016/j.arth.2014.12.001
  18. Mi B, Liu G, Lv H, et al. Is combined use of intravenous and intraarticular tranexamic acid superior to intravenous or intraarticular tranexamic acid alone in total knee arthroplasty? A meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12:61. https://doi.org/10.1186/s13018-017-0559-2
  19. Box HN, Tisano BS, Khazzam M. Tranexamic acid administration for anatomic and reverse total shoulder arthroplasty: a systematic review and meta-analysis. JSES Open Access. 2018;2:28-33. https://doi.org/10.1016/j.jses.2017.12.004
  20. Duncan CM, Gillette BP, Jacob AK, Sierra RJ, Sanchez-Sotelo J, Smith HM. Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty. J Arthroplasty. 2015;30:272-6. https://doi.org/10.1016/j.arth.2014.08.022
  21. Sukeik M, Alshryda S, Haddad FS, Mason JM. Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011;93:39-46.
  22. Carbone A, Poeran J, Zubizarreta N, et al. Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events. J Shoulder Elbow Surg. 2021;30:104-12. https://doi.org/10.1016/j.jse.2020.04.050
  23. Bridges KH, Wilson SH. Acute coronary artery thrombus after tranexamic acid during total shoulder arthroplasty in a patient with coronary stents: a case report. A A Pract. 2018;10:212-4. https://doi.org/10.1213/XAA.0000000000000667
  24. Fillingham YA, Kayupov E, Plummer DR, Moric M, Gerlinger TL, Della Valle CJ. The James A. Rand Young Investigator's Award: a randomized controlled trial of oral and intravenous tranexamic acid in total knee arthroplasty: the same efficacy at lower cost? J Arthroplasty. 2016;31(9 Suppl):26-30. https://doi.org/10.1016/j.arth.2016.02.081