EFFECTS OF TRANEXAMIC ACID IN THE WIDE RECONSTRUCTIVE SURGERY ON HIP JOINT

The wide surgery on hip joint is followed by the blood loss, local and systematic inflammatory response. Tranexamic acid is widely used in surgery for conservative homeostasis and its anti-inflammatory effect is also well known. The purpose: to justify the dosing regimen of tranexamic acid from the position of minimum blood loss and inflammatory response. Materials and methods: 32 patients from the control group received standard therapy with tranexamic acid at the dose of 20 mg/kg intravenously twice a day: 30 minutes prior to the surgery and in 6 hours since the 1st administration; in the main group (29 patients) the standard regimen was supplemented by intra-operative administration – 10 mg per kg-1 ∙ h-1. Results. The volume of the intra-surgery, drainage, general and estimated peri-operative blood loss was not statistically different between two groups. The level of pro-inflammatory and anti-inflammatory cytokines was higher in the drainage blood compared to the peripheral one (p < 0.001). The concentration of soluble receptors to IL-6 and FNO-α was statistically and clinically confidently higher in the control group compared to the main one at the majority stages of the study (p < 0.05). Conclusion. Tranexamic acid possesses anti-inflammatory action regardless of the dose.

1. Gusev E.Yu., Yurchenko L.N., Chereshnev V.А. et al. Studying methods of system inflammation. Tsitokiny i Vospaleniye, 2008, vol. 7, no. 1, pp. 15-23. (In Russ.)

2. Prokhorenko T.S., Saprina T.V., Lazarenko F.E. et al. System of α-tumor necrosis factor in pathogenesis of autoimmune diabetes. Bulleten’ Sib. Med., 2011, no. 1, pp. 64-69. (In Russ.)

3. Shevchenko Yu.L., Stoyko Yu.M., Zamyatin M.N. et al. Blood saving effect of tranexamic acid in knee joint prosthetic repair. Obsch. Reanimatologiya, 2008, vol. 12, no. 6, pp. 1-4. (In Russ.)

4. Bastian D., Tamburstuen M.V., Lyngstadaas S.P. et al. Systemic and local cyto-kine kinetics after total hip replacement surgery. Eur. Surg. Res., 2008, vol. 41, no. 4, pp. 334-340.

5. Clementsen T., Krohn C.D., Reikeras O. Systemic and local cytokine patterns during total hip surgery. Scand. J. Clin. Lab. Invest., 2006, vol. 66, no. 6, pp. 535-542.

6. Haghes S.F., Hendricks B.D., Edwards D.R. et al. Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures. Eur. J. Med. Res., 2013, vol. 18, pp. 40. http://www.eurjmedres.com/content/18/1/40

7. Jimenez J.J., Iribarren J.L., Lorente L. et al. Safety and effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, do-sedependent, phase IV clinical trial. J. Cardiothoracic Surg., 2011, vol. 6, pp. 138. http://www.cardiothoracicsurgery.org/content/6/1/138

8. Jimenez J.J., Iribarren J.L., Lorente L. et al. Tranexamic acid attenuates inflammatory response in cardiopulmonary bypass surgery through blockade of fibrinolysis: a case control study followed by a randomized double-blind controlled trial. Crit. Care, 2007, vol. 11, no. 6, R.117 (doi:10.1186/cc6173). http://ccforum. com/content/11/6/R117

9. Ker K., Edwards P., Perel P. et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ, 2012, vol. 344, e3054-e3067. doi: 10.1136/bmj.e3054

10. Ker K., Prieto-Merino D., Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br. J. Surg., 2013, vol. 100, no. 10, pp. 1271-1279.

11. Levy J.H. Anti-inflammatory strategies and hemostatic agents: old drugs, new ideas. Hematol. Oncol. Clin. North. Am., 2007, vol. 21, no. 1, pp. 89-101.

12. Li Z.J., Fu X., Xing D. et al. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur. Spine J., 2013, vol. 22, pp. 1950-1957.

13. Nadler S.B., Hidalgo J.H., Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, vol. 51, no. 2, pp. 224-232.

14. Ng W.C., Jerath A., Wasowicz M. Tranexamic acid: a clinical review. Anaesthesiology Intensive Therapy, 2015, vol. 47, no. 4, pp. 339-350.

15. Poeran J., Rasul R., Suzuki S. et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ, 2014, vol. 349, g4829-g4839. doi: 10.1136/bmj.g4829.

16. Vel R., Udupi B.P., Prakash M.V. et al. Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients. Saudi. J. Anaesth., 2015, vol. 9, no. 1, pp. 42-48.