L’acido tranexamico per la prevenzione delle trasfusioni negli interventi di artroplastica: una pratica costo/efficace

[Machine translation] Objectives: Tranexamic acid (TXA), administered before prosthetic interventions, is able to prevent intra- and peri-operative bleeding events by reducing the need for transfusions. The objectives of the present study are the evaluation of TXA in reducing the need for transfusions among patients undergoing arthroplasty surgery, and the cost/benefit assessment of this practice. Methods: The study population includes 198 patients who underwent arthroplasty surgery, of which 100 were operated between June 1, 2008 and October 31, 2008 and did not receive pharmacological treatment, and 98 were operated between June 1, 2009 and October 31, 2009 and received the study drug. The primary outcome is the frequency of transfusions in the two groups, using the transfusion event as a proxy measure of intra/peri-operative bleeding. Independent risk factors associated with the transfusion event were evaluated using multivariate logistic regression models. Cost/benefit analyses were performed considering the costs related to the autologous blood donation procedure, drug administration, autotransfusion procedures and homologous blood transfusions. Results: In the multivariate analysis, the administration of TXA, hip arthroplasty and high pre-operative hemoglobin (Hb) values are significantly protective against the transfusion event. 75% of patients not treated with TXA received at least one transfusion compared to 40.8% of patients exposed to TXA, a reduction of 45.6%. The average number of blood sacs transferred also decreased in the TXA group, with a greater reduction in hip operations compared to knee surgeries, by 2.3 (±1.2) and 1.6 (± 0.9), respectively. The reduction in Hb levels was lower in patients who received TXA both on the first day and on the second day (p<0.001). The cost analysis showed an average reduction of 133 euros per patient in the TXA group compared to the control group. Considering the approximately 140,000 arthroplasty procedures performed annually in Italy, the introduction of this technology on a large scale could lead to a large reduction in transfusion costs in this type of intervention for the National Health System (NHS). Conclusions: The administration of TXA during arthroplasty surgery reduces the need for transfusions in operated patients and the associated costs. Therefore, this procedure can be considered a cost/effective practice for the NHS.