Eficácia de diferentes doses e esquemas de administração de ácido tranexâmico em cirurgias ortopédicas de grande porte: estudo randomizado

Abstract

Background

Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication.

Methods

Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each: placebo, low dose (bolus 10 mg.kg^‐1), low dose + maintenance (bolus 10 mg.kg^‐1 + maintenance 1 mg.kg^‐1.hr^‐1), high dose (bolus 30 mg.kg^‐1) and high dose + maintenance (bolus 30 mg.kg^‐1 + maintenance 3 mg.kg^‐1.hr^‐1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period.

Results

The intraoperative blood loss was 440 ± 207.54 mL in the placebo group, 412.5 ± 208.21 mL in the low dose group, 290 ± 149.6 ml in the low dose plus maintenance group, 332.5 ± 162.33 mL in the high dose group and 240.7 ± 88.15 mL in the high dose maintenance group (p < 0.001). The reduction in postoperative blood loss in the drain for the first 24 hours was 80 ± 44.44 mL in the placebo group, 89.88 ± 44.87 mL in the low dose group, 56.7 ± 29.12 mL in the low dose plus maintenance group, 77.9 ± 35.74 mL in the high dose group and 46.7 ± 19.9 mL in the high dose maintenance group (p < 0.001). DVT was not encountered in any patient.

Conclusion

Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose + maintenance group.