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Akcaalan S, Akcan G, Tufan AC, Caglar C, Akcaalan Y, Akkaya M, Dogan M. Is tranexamic acid safe for the hip joint? NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:1197-1207. [PMID: 37644283 DOI: 10.1007/s00210-023-02693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
To show the effects of tranexamic acid, which is a drug frequently used to control bleeding, on the hip joint and sciatic nerve in animal experiments. There were 15 rats in each of the 3 groups, with a total of 45 rats. Topical saline injections were applied to the first group, topical TXA injections to the second group, and intravenous (IV) TXA injections to the third group. In the samples taken from the hip joint 3 weeks later, femoral head cartilage, sciatic nerve, and joint capsule thicknesses were analyzed histologically. Statistically significantly more cartilage degradation was detected in the femoral head cartilage in both the IV and intraarticular TXA group when compared to the control group. The groups were also compared in terms of acetabular cartilage; however, no histological difference was found between the groups. It was seen that when the femoral head cartilage thickness (the average of the measurements made from 3 different points were used) was examined, the cartilage thickness in the topical TXA group was less when compared to the other 2 groups. However, this difference was determined to not be statistically significant. The data of the hip joint capsule thickness measurement, it was found that the capsule thickness in the topical TXA applied group was less when compared to the other 2 groups. However, this difference was not statistically significant. When the sciatic nerves in all 3 groups were compared, no different staining characteristics were found in the immunofluorescence examination. TXA, which is frequently used in orthopedic practice, shows negative effects on hip joint cartilage in both topical and intravenous application.
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Affiliation(s)
- Serhat Akcaalan
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, 06800, Ankara, Turkey.
| | - Gulben Akcan
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, 06800, Ankara, Turkey
| | - Ahmet Cevik Tufan
- Department of Histology and Embryology, Ankara Yıldırım Beyazıt University, 06800, Ankara, Turkey
| | - Ceyhun Caglar
- Department of Orthopedics and Traumatology, Ankara City Hospital, 06800, Ankara, Turkey
| | | | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, 06800, Ankara, Turkey
| | - Metin Dogan
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, 06800, Ankara, Turkey
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Circi E, Atici Y, Baris A, Senel A, Leblebici C, Tekin SB, Ozturkmen Y. Is Tranexamic Acid an Effective Prevention in the Formation of Epidural Fibrosis? Histological Evaluation in the Rats. J Korean Neurosurg Soc 2023; 66:503-510. [PMID: 37334444 PMCID: PMC10483163 DOI: 10.3340/jkns.2022.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE The present study aimed to determine the topical and systemic efficacy of tranexamic acid (TXA) on epidural fibrosis in a rat laminectomy model. METHODS Thirty-two 12-month-old adult Sprague-Dawley rats were used in this study. Each rat underwent bilateral laminectomy at the L1 and L2 vertebral levels. Rats were divided into four groups : in group I (control group, n=8), a laminectomy was performed and saline solution was applied into the surgical space. In group II (topical group, n=8), laminectomy was performed and 30 mg/ kg TXA was applied to the surgical site before skin closure. In group III (systemic group, n=8), 30 mg/kg TXA was administered intravenously via the tail vein in the same session as the surgical procedure. In group IV (topical and systemic group, n=8), TXA was administered 30 mg/kg both topical and intravenous. The rats were sacrificed at 4 weeks postoperatively. Masson's trichrome and hematoxylin and eosin were used to assess acute inflammatory cells, chronic inflammatory cells, vascular proliferation, and epidural fibrosis. RESULTS Epidural fibrosis, acute inflammation, chronic inflammation, and sum histologic score value were significantly lower in the systemic TXA group, systemic and topical TXA groups than in the control group (p<0.05). In addion, the sum histologic score was significantly lower in the topical TXA group than in the control group (p<0.05). CONCLUSION In this study, epidural fibrosis formation was prevented more by systemic application, but the topical application was found to be effective when compared to the control group. As a result, we recommend the systemic and topical use of TXA to prevent epidural fibrosis during spinal surgery.
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Affiliation(s)
- Esra Circi
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Yunus Atici
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Alican Baris
- Department of Orthopaedics and Traumatology, Istanbul Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Senel
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Saltuk Bugra Tekin
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
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Adak BM, Laçin N, Şimşek F, Uysal E, Soylu FE, Özkan İ. Evaluation of the effects of different hemostatic agent applications on mental nerve. Eur Arch Otorhinolaryngol 2022; 279:5355-5362. [PMID: 35767059 DOI: 10.1007/s00405-022-07434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Evaluating the effect of ABS (Ankaferd Blood Stopper®), Tranexamic Acid (Transamin®) and Thrombin-Containing Hemostatic Matrix (Floseal®) on the mental nerve of rats by using histopathologic and immunohistochemical analyses. MATERIALS AND METHODS 40 Wistar Albino rats were used. Rats were randomly selected into 4 groups as Control (G1), ABS (G2), Tranexamic Acid (G3) and Thrombin-Containing Hemostatic Matrix (G4). In the control group G1, the left mental nerve was exposed and 0.3 ml of sterile saline was applied for 5 min, then closed with suture. In the other three groups, the left mental nerve was exposed and 0.3 ml ABS, Tranexamic Acid and Floseal was applied to groups, respectively. After 5 min, wounds were closed with suture. Immunohistochemical and histopathologic examinations were performed on mental nerves after 28 days. RESULTS The total histopathologic and immunohistochemical semiquantitative scores were significantly higher in ABS (G2) compared to Control (G1), Tranexamic Acid (G3) and Thrombin-Containing Hemostatic Matrix (G4) (P < 0.05). Myelin thickness were significantly lower in G2 compared to G1, G2 and G3 (P < 0.05). G3 has the most reliable results compared to G2 and G4 (P < 0.05). CONCLUSION The study results suggest that ABS has neurotoxic effects and should not be used close to the nerve, and thrombin-containing hemostatic matrix should be used carefully. Tranexamic acid, on the other hand, was found to be the most reliable hemostatic agent for use in close proximity to neural tissues. Further studies are required to determine the efficacy of the hemostatic agents on peripheral nerve degeneration.
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Affiliation(s)
- Berat Metin Adak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Izmir Katip Çelebi University, 6780.sokak no: 48 Cigli, Izmir, Turkey.
| | - Nihat Laçin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Izmir Katip Çelebi University, 6780.sokak no: 48 Cigli, Izmir, Turkey
| | - Fatma Şimşek
- Department of Histology and Embryology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Ersin Uysal
- Deparment of Computer Technologies, Dicle University, Diyarbakir, Turkey
| | - Fahri Emrah Soylu
- Laboratory Animals Application and Research Center, Ege University, Izmir, Turkey
| | - İrem Özkan
- Department of Prosthetic Dentistry, Faculty of Dentistry, Izmir Katip Çelebi University, Izmir, Turkey
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Sahin E, Berk H, Ozkal S, Keskinoglu P, Balci P, Balci A. Effect of Local Tranexamic Acid on the Quality of Bone Healing in a Rat Spinal Fusion Model. Spine Surg Relat Res 2022; 6:151-158. [PMID: 35478981 PMCID: PMC8995122 DOI: 10.22603/ssrr.2021-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/31/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction The use of the antifibrinolytic agent tranexamic acid has positive effects on bleeding control, but our knowledge is still limited regarding how fibrinolysis suppression changes the process of bone formation and the quality of bone. Because of the several side effects of systemic tranexamic acid, topical usage has been established in several procedures. This study aimed to investigate the effect of local tranexamic acid on vertebral fusion by using macroscopic, radiologic, and microscopic techniques. We also attempted to determine the safe dose range in case some doses had negative effects on fusion. Methods Twenty-eight Wistar albino rats underwent intertransverse fusion. All rats were randomized into four groups: groups treated with local tranexamic acid doses of 1 mg/kg (D1), 10 mg/kg (D10), and 100 mg/kg (D100) and the control group with no drug (D0). At the end of the eighth week, all rats were sacrificed for evaluation in terms of palpation, mammography, and histopathologic analysis. Results The manual palpation results presented with lower fusion rates in D10 and D100 groups than in the control group. Radiological examination results were significantly higher in the control group. The histopathologic examination revealed no significant differences between groups in the percent of new bone formation. Conclusions Our results showed that local administration of tranexamic acid reduced the quality and stability of fusion without a delay in bone formation. However, doses of 1 mg/kg did not reduce the stability in the palpation test. Our findings suggest that 1 mg/kg dose is a critical threshold above which tranexamic acid reduced the bone healing process of fusion and that surgeons should consider the doses of local tranexamic acid during surgery.
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Affiliation(s)
- Ertugrul Sahin
- Department of Orthopaedics and Traumatology, Kemalpasa State Hospital
| | - Haluk Berk
- Department of Orthopaedics and Traumatology, Dokuz Eylul University School of Medicine
| | - Sermin Ozkal
- Department of Pathology, Dokuz Eylul University School of Medicine
| | - Pembe Keskinoglu
- Department of Biostatistics and Informatics, Dokuz Eylul University School of Medicine
| | - Pinar Balci
- Department of Radiology, Dokuz Eylul University School of Medicine
| | - Ali Balci
- Department of Radiology, Dokuz Eylul University School of Medicine
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Balkanlı B, Çopuroğlu C, Çopuroğlu E. The effects of intravenous and local tranexamic acid on bone healing: An experimental study in the rat tibia fracture model. Injury 2020; 51:2840-2845. [PMID: 32951917 DOI: 10.1016/j.injury.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic agent. It has long been used to reduce the need for perioperative blood loss in various surgeries. Few studies have investigated the effects of local and intravenous administration of TXA on fracture healing. Thus, we aimed to evaluate if TXA influences hematoma volume and fracture healing in the rat tibia fracture model. MATERIALS AND METHODS A tibia fracture with intramedullary Kirschner wire fixation was created in all animals. Rats were randomly divided into three groups as local TXA, intravenous TXA, and control. A dose of 50 mg/kg local and intravenous TXA was administered to the study groups. Hematoma volume was measured on the first and third days of the study. The animals were sacrificed on the 14th and 21st days for radiological and histopathological examinations. RESULTS There was no significant difference between the groups in terms of hematoma volume measured on Day 1 and the mean decrease of hematoma volume from Day 1 to Day 3 (p = 0.158 and p = 0.239, respectively). The total radiological scores of Day 14 and Day 21 were similar in all groups (p > 0.05 for all). There was also no significant difference between the histological staging of the fracture repair on Day 14 and Day 21 for all groups (p > 0.05 for all). CONCLUSION Our findings suggest that TXA's local and intravenous application makes no significant difference in fracture healing.
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Affiliation(s)
- Bahadır Balkanlı
- Zonguldak Atatürk State Hospital, Department of Orthopedics and Traumatology, Zonguldak, Turkey.
| | - Cem Çopuroğlu
- Trakya University, School of Medicine, Department of Orthopedics and Traumatology, Edirne, Turkey
| | - Elif Çopuroğlu
- Trakya University, School of Medicine, Department of Anesthesia and Reanimation, Edirne, Turkey
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Çevik HB, Eceviz E, Çilingir Kaya ÖT, Ercan F, Çeçen GS. The effect of topical and systemic tranexamic acid on fracture healing in rats. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:207-212. [PMID: 32254038 DOI: 10.5152/j.aott.2020.02.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of the present study was to determine the effect of topical and systemic tranexamic acid (TXA) on fracture healing in a rat surgical model. METHODS We created standard, right-sided, open, diaphyseal femoral fractures with intramedullary Kirschner wire fixation in 48 male rats and divided them into three groups: a topical TXA (10 mg/kg) group, a systemic TXA (10 mg/kg) group, and a control group. Fracture healing was evaluated radiographically and histologically after early (week 2) and late (week 4) postoperative sacrifice. RESULTS The radiological scores differed significantly among the all groups (p=0.001), as did the week 2 and 4 scores (p=0.003 and p=0.010, respectively). Radiologically, the topical TXA group exhibited better bone healing at both 2 (p=0.001) and 4 (p=0.007) weeks than the control group, and the systemic group showed better healing at both 2 (p=0.027) and 4 (p=0.023) weeks than the control TXA group. Moreover, bone healing was better in the group treated with topical rather than systemic TXA on radiological examinations performed at 2 (p=0.001) and 4 (p=0.007) weeks postoperatively (p=0.001 and p=0.007, respectively). Histologically, the groups differed significantly (p=0.001). The histological scores differed significantly among the all groups (p=0.001). At 2 weeks, the topical TXA group exhibited significantly better bone healing than the control group (p=0.001). CONCLUSION Our results suggested that topical application of TXA in fracture patients may accelerate healing, whereas systemic administration may adversely affect healing.
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Affiliation(s)
- Hüseyin Bilgehan Çevik
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey
| | - Engin Eceviz
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey
| | | | - Feriha Ercan
- Department of Histology and Embryology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Gültekin Sıtkı Çeçen
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey
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Comparing the efficacy of intravenous or intra-articular tranexamic acid in reducing blood loss in simultaneous bilateral knee replacement surgery without the use of tourniquet. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1417-1420. [PMID: 29594528 DOI: 10.1007/s00590-018-2194-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the effect of intravenous or intra-articular route of administration of tranexamic acid in reducing the blood loss in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquets. METHODS Prospective cohort study of 30 consecutive patients grouped into two groups; Group 1: intravenous group and group 2: intra-articular group. Two outcome measures were studied; mean drop in post-operative haemoglobin and need for blood transfusion in both groups. RESULTS No significant difference in mean drop of haemoglobin and need for blood transfusion in both groups. CONCLUSION Route of administration of tranexamic acid does not influence on the mean drop of haemoglobin and need for blood transfusion in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquet.
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