Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety

作者：Jashvant Poeran, Rehana Rasul, Suzuko Suzuki, Thomas Danninger, Madhu Mazumdar, Mathias Opperer, Friedrich Boettner, Stavros G. Memtsoudis · 发表于：BMJ · 年份：2014 · DOI：10.1136/bmj.g4829 · 被引用次数：470 · 研究领域：Blood transfusion and management、Total Knee Arthroplasty Outcomes、Orthopedic Infections and Treatments

OBJECTIVE: To determine the effectiveness and safety of perioperative tranexamic acid use in patients undergoing total hip or knee arthroplasty in the United States. DESIGN: Retrospective cohort study; multilevel multivariable logistic regression models measured the association between tranexamic acid use in the perioperative period and outcomes. SETTING: 510 US hospitals from the claims based Premier Perspective database for 2006-12. PARTICIPANTS: 872,416 patients who had total hip or knee arthroplasty. INTERVENTION: Perioperative intravenous tranexamic acid use by dose categories (none, ≤ 1000 mg, 2000 mg, and ≥ 3000 mg). MAIN OUTCOME MEASURES: Allogeneic or autologous transfusion, thromboembolic complications (pulmonary embolism, deep venous thrombosis), acute renal failure, and combined complications (thromboembolic complications, acute renal failure, cerebrovascular events, myocardial infarction, in-hospital mortality). RESULTS: While comparable regarding average age and comorbidity index, patients receiving tranexamic acid (versus those who did not) showed lower rates of allogeneic or autologous transfusion (7.7% v 20.1%), thromboembolic complications (0.6% v 0.8%), acute renal failure (1.2% v 1.6%), and combined complications (1.9% v 2.6%); all P<0.01. In the multilevel models, tranexamic acid dose categories (versus no tranexamic acid use) were associated with significantly (P<0.001) decreased odds for allogeneic or autologous blood transfusions (odds ratio 0.31 to 0....