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Balachandren N, Seshadri S, Yasmin E, Saab W, Gates C, Sayar Z, Cohen H, Webber L. Venous thromboembolism associated with medically assisted reproduction (MAR): British fertility society policy and practice guidance for assessment and prevention. HUM FERTIL 2024; 27:2352387. [PMID: 38804228 DOI: 10.1080/14647273.2024.2352387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
The association between Medically Assisted Reproduction (MAR) and thromboembolic complications has been reported widely in multiple published studies. Although venous thromboembolism (VTE) is not thought to be a common complication of MAR, it is associated with high morbidity and is often preventable. Since VTE usually occurs after completion of MAR treatment and is often managed outside of the treating fertility unit, these complications are likely to be underreported and there may be limited awareness of the risks among clinicians. As we continue to see a rise in the total number of MAR treatment cycles, particularly in women over 40 years of age, along with a steady increase in the number of fertility preservation cycles for both medical and social indications, it is likely that we will see an increase in absolute numbers of VTE complications. Currently, there is a lack of management guidance and reporting of VTE events associated with assisted conception treatment. The aim of this guidance is to provide clinicians with information on VTE risk factors, guidance on assessing VTE risk and the best practice recommendations on risk reducing strategies for individuals at risk of VTE undergoing ovarian stimulation and embryo transfer cycles.
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Affiliation(s)
| | | | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Wael Saab
- The Centre for Reproductive & Genetic Health, London, UK
| | - Carolyn Gates
- Department of Haematology, University College London Hospital, London, UK
| | - Zara Sayar
- Department of Haematology, University College London Hospital, London, UK
- Department of Haematology, Whittington Health NHS Trust, London, UK
| | - Hannah Cohen
- Department of Haematology, University College London Hospital, London, UK
| | - Lisa Webber
- Gynaecology & Reproductive Medicine, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, W2 1NY and Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore, Singapore
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Ragusa A, Ficarola F, Ferrari A, Spirito N, Ardovino M, Giraldi D, Stuzziero E, Rinaldo D, Procaccianti R, Larciprete G, De Luca C, D'Avino S, Principi G, Angioli R, Svelato A. Tranexamic acid versus oxytocin prophylaxis in reducing post-partum blood loss, in low-risk pregnant women: TRANOXY STUDY, a phase III randomized clinical trial. EClinicalMedicine 2024; 73:102665. [PMID: 38873634 PMCID: PMC11169955 DOI: 10.1016/j.eclinm.2024.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background To assess the equivalence of tranexamic acid (TRAN) versus synthetic oxytocin (OXY) in reducing post-partum blood loss, in full-term patients (37-42 weeks), at low risk of post-partum hemorrhage, with vaginal childbirth. Methods Phase III, randomized (1:1), open-label, longitudinal, multi-center, prospective clinical trial (Prot. n 63209, ClinicalTrials.gov Identifier: NCT02775773). From January 7, 2020, to June 30, 2023, a total of 256 women were enrolled at two general urban community hospitals in Italy, serving a multi-ethnic patient population with National Health Insurance. The primary outcome was to explore a potential equivalence between the two treatments (OXY and TRAN) in preventing total blood loss. Therefore, we randomized 231 women into two groups: Group A (OXY), 127 women who were administered 10UI intramuscularly within 5 min from childbirth; Group B (TRAN), 104 women to whom 1-g slow intravenous infusion was administered within 5 min from childbirth. Findings At the time of delivery, mean blood loss for OXY group versus TRAN group was 269.12 mL versus 263.88 mL, respectively, with equivalence between the two groups. Similarly, there was equivalence in total blood loss between the OXY and the TRAN group (397.66 mL versus 405.64 mL, respectively. No statistical differences between Hb levels at admission and discharge in the two groups were reported. No difference was found in terms of additional uterotonic and surgical therapies between the two groups of patients. Neither group showed thrombotic complications at check-up performed after 7 days or after a questionnaire regarding adverse effects, subjected after 40 days. Interpretation The study shows the equivalence of tranexamic acid versus synthetic oxytocin in post-partum blood loss prophylaxis in term patients at low risk of PPH with vaginal childbirth. The safety profiles of OXY and TRAN were similar. Funding None.
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Affiliation(s)
- Antonio Ragusa
- Department of Obstetrics and Gynecology, Maggiore Hospital Carlo Alberto Pizzardi Bologna, Italy
| | - Fernando Ficarola
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Unit of Gynecology, Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant’Anna School of Advanced Studies, Pisa, Italy
| | - Nicoletta Spirito
- Department of Obstetrics and Gynecology, Ospedale Apuane, Massa Carrara, Italy
| | - Mario Ardovino
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Domenico Giraldi
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Elisario Stuzziero
- Department of Obstetrics and Gynecology, Ospedale S.G. Moscati, Avellino, Italy
| | - Denise Rinaldo
- Department of Obstetrics and Gynecology, ASST Bergamo Est, Bolognini Hospital, Seriate, Italy
| | - Roberto Procaccianti
- Department of Gynecology and Obstetrics, Fondazione Istituto San Raffaele G Giglio, Cefalù, Italy
| | - Giovanni Larciprete
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Caterina De Luca
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
| | - Giulia Principi
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - Roberto Angioli
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, Fatebenefratelli Gemelli Hospital, Isola Tiberina, Roma, Italy
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Zhang Y, Zhang L. Reply to: Letter to the Editor Concerning "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with PELD" by Kim et al. J Neurol Surg A Cent Eur Neurosurg 2024; 85:437-438. [PMID: 38151029 DOI: 10.1055/a-2235-5524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
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Franchini M, Focosi D, Mannucci PM. Tranexamic Acid: An Evergreen Hemostatic Agent. Semin Thromb Hemost 2024; 50:733-738. [PMID: 38335995 DOI: 10.1055/s-0044-1779632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Tranexamic acid (TXA) is an important antifibrinolytic agent, which inhibits plasminogen activation and fibrinolysis. Several controlled randomized trials have investigated the role of TXA in preventing or decreasing blood loss across different surgical interventions or medical conditions characterized by excessive bleeding, consistently documenting its effectiveness and safety. Although the first clinical use of TXA dates back to more than 60 years ago, TXA remains the focus of intense research. This narrative review summarizes the more recent results and indications on the clinical use of TXA.
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Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantua, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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Zhu C, Ji Z, Zhu J, Xu H, Li S, Liu C, Wei B. Perioperative Administration of Tranexamic Acid and Low Molecular Weight Heparin for Enhanced Blood Management in Intertrochanteric Fractures: A Randomized Controlled Study. Med Sci Monit 2024; 30:e944063. [PMID: 38875178 PMCID: PMC11184985 DOI: 10.12659/msm.944063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/24/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND This prospective study from a single center aimed to compare the perioperative blood loss (PBL) in 79 patients with intertrochanteric fractures (IF) treated with intramedullary nailing (IMN) using 3 regimens of combined tranexamic acid (TXA) and low molecular weight heparin (LMWH), proposing a novel therapy of 4-dose TXA. MATERIAL AND METHODS We recruited 79 patients and randomly divided them into 3 groups. The 4-dose TXA group (22 patients) received 1.0 g intravenous TXA 30 min before surgery and 1.0 g at intervals of 3, 6, and 9 h before surgery. The 1-dose TXA group (25 patients) received 1.0 g intravenous TXA 30 min before surgery, while the control group (32 patients) did not receive TXA. LMWH was applied 12 h after surgery in each group. The primary metrics evaluated included hidden blood loss (HBL), total blood loss (TBL), and the number and incidence rate of deep vein thrombosis (DVT). RESULTS Analysis of the HBL revealed that the 4-dose TXA group had the lowest average (583.13±318.08 ml), followed by the 1-dose TXA group (902.94±509.99 ml), and the control group showed the highest (1154.39±452.06 ml) (P<0.05). A similar result was observed for TBL (4-dose group: 640.86±337.22 ml, 1-dose group: 971.74±511.14 ml, control group: 1226.27±458.22 ml, P<0.05). Regarding DVT, the 4-dose TXA group had 5 cases (incidence rate 22.73%), the 1-dose TXA group had 6 cases (incidence rate 24.00%), and the control group had 8 cases (incidence rate 25.00%), with no significant difference among groups (P>0.05). CONCLUSIONS Treatment using 4-dose TXA and LMWH can effectively reduce PBL without increasing the DVT risk in IF patients with IMN.
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Roberts I, Murphy MF, Moonesinghe R, Grocott MPW, Kalumbi C, Sayers R, Toh CH. Wider use of tranexamic acid to reduce surgical bleeding could benefit patients and health systems. BMJ 2024; 385:e079444. [PMID: 38866414 PMCID: PMC11170764 DOI: 10.1136/bmj-2024-079444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Affiliation(s)
- Ian Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Ramani Moonesinghe
- NHS England, London, UK
- Centre for Perioperative Medicine, University College London, London, UK
| | - Michael P W Grocott
- Royal College of Anaesthetists, London, UK
- Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
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Park JH, Siddiqui N, Hrebec WK, Szymanski TJ, Uribe-Marquez S, Miletic KG, Krishnan S. Management of Anticoagulation and Antifibrinolytics in Catastrophic Antiphospholipid Syndrome. Semin Cardiothorac Vasc Anesth 2024:10892532241249782. [PMID: 38705843 DOI: 10.1177/10892532241249782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder that presents with hypercoagulability and results in a lab artifact of prolonged PTT. The most severe form is catastrophic antiphospholipid antibody syndrome (CAPS), which manifests as rapidly progressing thromboses in multiple organ systems leading to multi-organ ischemia. The mainstay management CAPS is anticoagulation and systemic corticosteroids. Antifibrinolytic agents have previously been thought to be relatively contraindicated in CAPS due to the pro-thrombotic nature of the disease; the complex coagulation profile of CAPS can make it difficult to assess the risks and benefits of antifibrinolytic therapy. Also, should a patient with CAPS require cardiopulmonary bypass (CPB) for surgery, it poses a unique challenge in providing appropriate anticoagulation in the setting of prolonged ACT. We present a case of a 32-year-old postpartum female with CAPS requiring heart transplant who safely received intraoperative antifibrinolytic therapy and was successfully anticoagulated during CPB after perioperative plasmapheresis.
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Affiliation(s)
- Jee Ha Park
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nazia Siddiqui
- Department of Anesthesiology, Trinity Health Oakland Hospital, Pontiac, MI, USA
- Department of Anesthesiology, Henry Ford Hospital, Detroit, MI, USA
| | - William K Hrebec
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Kyle G Miletic
- Department of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Sandeep Krishnan
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Anesthesiology, Trinity Health Oakland Hospital, Pontiac, MI, USA
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Rifkin WJ, Parker A, Bluebond-Langner R. Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma. Plast Reconstr Surg 2024; 153:1002e-1010e. [PMID: 37399532 DOI: 10.1097/prs.0000000000010892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The established safety and efficacy of tranexamic acid (TXA) in minimizing perioperative blood loss has led to increased interest within plastic surgery. Prior studies have demonstrated decreased edema and ecchymosis and reduced rates of postoperative collection with administration of TXA; however, its use has not been reported in gender-affirming mastectomy. This represents the first study to evaluate the effects of TXA on postoperative outcomes in patients undergoing gender-affirming mastectomy. METHODS A single-center cohort study was performed analyzing all consecutive patients undergoing gender-affirming mastectomy with the senior author (R.B.-L.) between February of 2017 and October of 2022. Beginning in June of 2021, all patients received 1000 mg of TXA intravenously before incision and 1000 mg at the conclusion of the procedure. Patients were stratified according to intraoperative administration of TXA, with demographic characteristics, surgical characteristics, and postoperative outcomes compared between groups. RESULTS A total of 851 patients underwent gender-affirming mastectomy. Of these, 646 cases were performed without TXA, and 205 patients received intravenous TXA intraoperatively, as described previously. Patients who received TXA had significantly lower rates of seroma (20.5% versus 33.0%; P < 0.001) and hematoma (0.5% versus 5.7%; P = 0.002). There was no difference in rates of surgical-site infection ( P = 0.74). TXA use was not associated with increased rates of venous thromboembolism ( P = 0.42). CONCLUSIONS Intraoperative administration of TXA in patients undergoing gender-affirming mastectomy may safely reduce the risk of postoperative seroma and hematoma without increased risk of thromboembolic events. Additional data collection and prospective studies are warranted to corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- William J Rifkin
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Augustus Parker
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Zahr T, Boda VK, Ge J, Yu L, Wu Z, Que J, Li W, Qiang L. Small molecule conjugates with selective estrogen receptor β agonism promote anti-aging benefits in metabolism and skin recovery. Acta Pharm Sin B 2024; 14:2137-2152. [PMID: 38799642 PMCID: PMC11119546 DOI: 10.1016/j.apsb.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 05/29/2024] Open
Abstract
Estrogen is imperative to mammalian reproductivity, metabolism, and aging. However, the hormone activating estrogen receptor (ERs) α can cause major safety concerns due to the enrichment of ERα in female tissues and certain malignancies. In contrast, ERβ is more broadly expressed in metabolic tissues and the skin. Thus, it is desirable to generate selective ERβ agonist conjugates for maximizing the therapeutic effects of ERs while minimizing the risks of ERα activation. Here, we report the design and production of small molecule conjugates containing selective non-steroid ERβ agonists Gtx878 or genistein. Treatment of aged mice with our synthesized conjugates improved aging-associated declines in insulin sensitivity, visceral adipose integrity, skeletal muscle function, and skin health, with validation in vitro. We further uncovered the benefits of ERβ conjugates in the skin using two inducible skin injury mouse models, showing increased skin basal cell proliferation, epidermal thickness, and wound healing. Therefore, our ERβ-selective agonist conjugates offer novel therapeutic potential to improve aging-associated conditions and aid in rejuvenating skin health.
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Affiliation(s)
- Tarik Zahr
- Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA
- Department of Molecular Pharmacology and Therapeutics, Columbia University, New York, NY 10032, USA
| | - Vijay K. Boda
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jian Ge
- Division of Digestive and Liver Diseases, Columbia University, New York, NY 10032, USA
- Center for Human Development, Columbia University, New York, NY 10027, USA
| | - Lexiang Yu
- Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
| | - Zhongzhi Wu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jianwen Que
- Division of Digestive and Liver Diseases, Columbia University, New York, NY 10032, USA
- Center for Human Development, Columbia University, New York, NY 10027, USA
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Wei Li
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Drug Discovery Center, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Li Qiang
- Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, USA
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Marous CL, Farhat OJ, Cefalu M, Rothschild MI, Alapati S, Wladis EJ. Effects of Preoperative Intravenous Versus Subcutaneous Tranexamic Acid on Postoperative Periorbital Ecchymosis and Edema Following Upper Eyelid Blepharoplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled, Comparative Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00379. [PMID: 38687303 DOI: 10.1097/iop.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE To compare the effects of preoperative tranexamic acid (TXA) administered intravenously (IV) versus subcutaneously on postoperative ecchymosis and edema in patients undergoing bilateral upper eyelid blepharoplasty. METHODS A prospective, double-blinded, placebo-controlled study of patients undergoing bilateral upper eyelid blepharoplasty at a single-center. Eligible participants were randomized to preoperatively receive either (1) 1 g of TXA in 100 ml normal saline IV, (2) 50 µl/ml of TXA in local anesthesia, or (3) no TXA. Primary outcomes included ecchymosis and edema at postoperative day 1 (POD1) and 7 (POD7). Secondary outcomes included operative time, pain, time until resuming activities of daily living, patient satisfaction, and adverse events. RESULTS By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), ecchymosis scores were significantly lower on POD1 (1.31 vs. 1.56 vs. 2.09, p = 0.02) and on POD7 (0.51 vs. 0.66 vs. 0.98, p = 0.04) among those that received TXA. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), significant reductions in edema scores occurred in those that received TXA on POD1 (1.59 vs. 1.43 vs. 1.91, p = 0.005) and on POD7 (0.85 vs. 0.60 vs. 0.99, p = 0.04). By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA) patients treated with intravenous and local subcutaneous TXA preoperatively were more likely to experience shorter operative times (10.8 vs. 11.8 vs. 12.9 minutes, p = 0.01), reduced time to resuming activities of daily livings (1.6 vs. 1.6 vs. 2.3 days, p < 0.0001), and higher satisfaction scores at POD1 (8.8 vs. 8.7 vs. 7.9, p = 0.0002). No adverse events occurred were reported. CONCLUSION In an analysis of 106 patients, preoperative TXA administered either IV or subcutaneously safely reduced postoperative ecchymosis and edema in patients undergoing upper eyelid blepharoplasty. While statistical superiority between intravenous versus local subcutaneous TXA treatment was not definitively identified, our results suggest clinical superiority with IV dosing.
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Affiliation(s)
- Charlotte L Marous
- Oculoplastic and Orbital Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | - Omar J Farhat
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | - Matthew Cefalu
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
| | | | | | - Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College
- Department of Otolaryngology and Head and Neck Surgery, Albany Medical College, Albany, New York, U.S.A
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Tan G, Li J, Xu J, Zhu Y, Zhang H. The efficacy and safety of different does of intravenous tranexamic acid on blood loss in fresh foot and ankle fractures: a prospective, randomized controlled study. BMC Musculoskelet Disord 2024; 25:274. [PMID: 38589854 PMCID: PMC11003133 DOI: 10.1186/s12891-024-07410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND There are a few studies on the effectiveness and safety of intravenous administration of tranexamic acid(TXA) in patients who underwent foot and ankle surgery, especially for preoperative hidden blood loss in patients with freshfoot and ankle fractures. Thus, the aim of this study was to investigate whether intravenous administration of different doses of TXA can effectively reduce perioperative blood loss and blood loss before surgery and to determine its safety. METHODS A total of 150 patients with fresh closed foot and ankle fractures from July 2021 to July 2023 were randomly divided into a control group (placebo controlled [PC]), standard-dose group (low-dose group [LD], 1 g/24 h; medium-dose group [MD], 2 g/24 h), and high-dose group (HD, 3 g/24 h; ultrahigh-dose group [UD], 4 g/24 h). After admission, all patients completed hematological examinations as soon as possible and at multiple other time points postsurgery. RESULTS There was a significant difference in the incidence of hidden blood loss before the operation between the TXA group and the control group, and the effect was greater in the overdose groups than in the standard-dose groups. There were significant differences in surgical blood loss (intraoperative and postoperative), postoperative HGB changes, and hidden blood loss among the groups. The TXA groups showed a significant decrease in blood loss compared to that of the control group, and the overdose groups had a more significant effect than the standard-dose groups. A total of 9 patients in the control group had early wound infection or poor healing, while only 1 patient in the other groups had this complication, and the difference among the groups was significant. No patients in any group suffered from late deep wound infection, cardiovascular or cerebrovascular events or symptomatic VTE. CONCLUSION This is the first study on whether TXA can reduce preoperative hidden blood loss in patients with freshfoot and ankle fractures. In our study, on the one hand, intravenous application of TXA after foot and ankle fractures as soon as possible can reduce preoperative blood loss and postoperative blood loss. On the other hand, TXA can also lower wound complications, and over-doses of TXA are more effective than standard doses. Moreover, overdoses of TXA do not increase the incidence of DVT.
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Affiliation(s)
- Gang Tan
- Department of Orthopaedics, West China Hospital of Sichuan University, No.37 of Guoxue lane, Wuhou District, Chengdu, Sichuan, 610041, China
- Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Li
- Department of Orthopaedics, West China Hospital of Sichuan University, No.37 of Guoxue lane, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Jing Xu
- Operating Room, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongzhan Zhu
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China.
| | - Hui Zhang
- Department of Orthopaedics, West China Hospital of Sichuan University, No.37 of Guoxue lane, Wuhou District, Chengdu, Sichuan, 610041, China.
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Upfill-Brown A, Olson T, Adejuyigbe B, Shah A, Sheppard W, Park CW, Heo DH, Park DY. Does the use of tranexamic acid intraoperatively reduce postoperative blood loss and complications following biportal endoscopic lumbosacral decompression? JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:68-79. [PMID: 38567010 PMCID: PMC10982914 DOI: 10.21037/jss-23-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024]
Abstract
Background Biportal endoscopic spine surgery is an effective minimally invasive technique for treating common lumbar pathologies. We aim to evaluate the impact of intraoperative tranexamic acid (TXA) use on postoperative blood loss in biportal endoscopic decompression surgery. Methods Patients undergoing biportal endoscopic lumbar discectomies and decompressions either by same day surgery or overnight stay at a single institution beginning in October 2021 were prospectively enrolled. This study was non-randomized, non-blinded with the first cohort of consecutive patients receiving 1 g of intravenous TXA intra-operatively before closure and the second cohort of consecutive patients receiving no TXA. Exclusion criteria included any revision surgery, any surgery for the diagnosis of spinal instability, infection, tumor, or trauma, any contraindication for TXA. Results Eighty-four patients were included in the study, with 45 (54%) receiving TXA and 39 (46%) not receiving TXA. Median follow-up was 168 days [interquartile range (IQR), 85-368 days]. There were no differences in patient or surgical characteristics between cohorts. Estimated blood loss (EBL) was similar (P=0.20), while post-operative drain output was significantly lower in the TXA cohort (P=0.0028). Single level discectomies had significantly less drain output as compared to 2 level unilateral laminotomy, bilateral decompression (ULBD) cases (P<0.005). Post-operative complications were similar, with low rates of wound complication (1.2%) and transient postoperative weakness (2.4%, P>0.99 for both). Oswestry disability index (ODI), visual analog scale (VAS) back and VAS leg scores decreased significantly; the absolute decrease in scores did not differ between groups (P=0.71, 0.22, 0.86, respectively). Conclusions Systemic intraoperative TXA administration is associated with a significant decrease in post-operative blood loss in biportal spinal endoscopy, with no impact on the improvement in patient-reported outcomes (PROs) or rate of post-operative complications. Single level biportal discectomies had significantly less postoperative drainage with TXA and may not need drains postoperatively. Larger, randomized studies are necessary to evaluate the cost-effectiveness of TXA use in biportal spinal endoscopy.
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Affiliation(s)
- Alexander Upfill-Brown
- Department of Orthopaedic Surgery, Spine Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas Olson
- Department of Orthopaedic Surgery, Spine Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Babapelumi Adejuyigbe
- Department of Orthopaedic Surgery, Spine Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Akash Shah
- Department of Orthopaedic Surgery, Spine Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - William Sheppard
- Department of Orthopaedic Surgery, Spine Division, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Cheol Wung Park
- Department of Neurosurgery, Woori Hospital, Seoul, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Harrison Spinartus Hospital Chungdam, Seoul, South Korea
| | - Don Young Park
- Department of Orthopaedic Surgery, Spine Division, UC Irvine School of Medicine, Orange, CA, USA
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Halvorsen S, Mehilli J, Choorapoikayil S, Zacharowski K. Extract from the 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery - Patient Blood Management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:122-129. [PMID: 38063786 PMCID: PMC10920069 DOI: 10.2450/bloodtransfus.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The 2022 Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology are an update on the previous guidelines reported in 2014. The revised guidelines provide standardized perioperative cardiovascular management of surgical patients and emphasis on risk assessment of the patient combined with the inherent risk of the surgical procedure. One of the novelties in these guidelines is the Patient Blood Management programme, which is based on a three pillar concept: preoperative hemoglobin optimization, minimize iatrogenic blood loss and bleeding, and harness tolerance to anemia in an effort to improve patient outcome. In this review, we highlight the three pillars of Patient Blood Management and recommendations made by the 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery.
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Affiliation(s)
- Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway
| | - Julinda Mehilli
- Department of Cardiology, Pneumology and Intensive Medicine, Hospital Landshut-Achdorf, Landshut, Germany
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Suma Choorapoikayil
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
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Ziegler Rodríguez OR, De la Cruz Ku G, Chávez Díaz M, Ziegler Rodríguez GJ, Ziegler Gutiérrez OE. Safety and Outcomes in Multiplane Facial Rejuvenation with Tranexamic Acid: A Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5653. [PMID: 38463701 PMCID: PMC10923354 DOI: 10.1097/gox.0000000000005653] [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: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Background Tranexamic acid (TXA) has demonstrated promising outcomes in plastic surgery. Our aim was to assess the effect of TXA in intraoperative bleeding, operative time, and complications among patients undergoing facial surgical procedures. Methods A retrospective cohort study of patients who underwent multiplane facial rhytidectomy from January 2018 to September 2022 at the Clinica Ziegler, Lima, Peru. Patients were divided into two groups according to the use of intravenous plus local infiltration of TXA. We performed the chi square test to assess associations among categorical variables, the Student t test and Mann-Whitney U test for categorical with continuous variables, and Pearson correlation for quantitative variables. Results A total of 100 patients were included with 50 patients in each group. The median age was 59.5 years and the majority were women (88%). The median operative time was 288.5 minutes. The TXA group presented less intraoperative bleeding (40 versus 90 mL, P < 0.05) and shorter operative time (237 versus 353 minutes, P < 0.05); no differences in the development of hematoma (2% versus 12%, P = 0.11), less ecchymosis (2% versus 36%, P < 0.05), edema (2% versus 100%, P < 0.05), and time to drain removal (3 versus 6 days, P < 0.05). Conclusions TXA improves the short- and long-term outcomes of patients who undergo multiplane facial rhytidectomy. It also decreases intraoperative bleeding by more than half and reduces the operative time by one third. Moreover, patients receiving TXA presented significantly less ecchymosis, edema, and time to drain removal.
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Affiliation(s)
- Otto Rolando Ziegler Rodríguez
- From the Department of Aesthetic, Plastic and Reconstructive Surgery, Clínica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicadas Lima, Peru
| | - Gabriel De la Cruz Ku
- University of Massachusetts Medical School, Worcester, Mass
- Universidad Cientifica del Sur, Lima, Peru
| | - Marcelo Chávez Díaz
- From the Department of Aesthetic, Plastic and Reconstructive Surgery, Clínica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicadas Lima, Peru
| | - Gonzalo Javier Ziegler Rodríguez
- From the Department of Aesthetic, Plastic and Reconstructive Surgery, Clínica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicadas Lima, Peru
| | - Otto Enrique Ziegler Gutiérrez
- From the Department of Aesthetic, Plastic and Reconstructive Surgery, Clínica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicadas Lima, Peru
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15
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Yokoi H, Chakravarthy V, Winkleman R, Manlapaz M, Krishnaney A. Incorporation of Blood and Fluid Management Within an Enhanced Recovery after Surgery Protocol in Complex Spine Surgery. Global Spine J 2024; 14:639-646. [PMID: 35998380 PMCID: PMC10802530 DOI: 10.1177/21925682221120399] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN retrospective review. OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a multidisciplinary set of evidence-based interventions to reduce morbidity and accelerate postoperative recovery. Complex spine surgery carries high risks of perioperative blood loss, blood transfusion, and suboptimal fluid states. This study evaluates the efficacy of a perioperative fluid and blood management component comprised of a restrictive transfusion policy, goal directed fluid management, number of tranexamic acid (TXA) utilization, and autologous blood transfusion within our ERAS protocol for complex spine surgery. METHODS A retrospective review compared patients undergoing elective complex spine surgery prior to and following implementation of an ERAS protocol with intraoperative blood and fluid management. Outcomes included incidence of blood transfusion, estimated blood loss, intraoperative crystalloids administered, frequency of intraoperative TXA utilized, incidence of patients extubated within the operating room (OR), intensive care unit (ICU) admission, and hospital length of stay. RESULTS Following implementation, the rate of blood transfusion decreased by 11.7%(P = .017) and average crystalloid infusion was reduced 680 mL per case(P < .001). Intraoperative blood loss decreased on average 342 mL per case(P = .001) and TXA use increased significantly by 25%(P < .001). Postoperative ICU admissions declined by 8.5%(P = .071); extubation within the OR increased by 13.3%(P = .005). CONCLUSIONS This protocol presents a unique perspective with the inclusion of an interdisciplinary and comprehensive blood and fluid management protocol as an integral part of our ERAS pathway for complex spine surgery. These results indicate that a standardized approach is associated with reduced rates of blood transfusion and optimized fluid states which was correlated with decreased postoperative ICU admissions.
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Affiliation(s)
- Hana Yokoi
- Department of Neurosurgery, Cleveland Clinic, Cleveland OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Robert Winkleman
- Department of Neurosurgery, Cleveland Clinic, Cleveland OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mariel Manlapaz
- Department of Anesthesiology, Cleveland Clinic, Cleveland OH, USA
| | - Ajit Krishnaney
- Department of Neurosurgery, Cleveland Clinic, Cleveland OH, USA
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Wang C, Lebedeva V, Yang J, Anih J, Park LJ, Paczkowski F, Roshanov PS. Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis. Perioper Med (Lond) 2024; 13:5. [PMID: 38263259 PMCID: PMC10804695 DOI: 10.1186/s13741-023-00358-4] [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: 10/18/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
We systematically reviewed the literature to investigate the effects of peri-procedural desmopressin in patients without known inherited bleeding disorders undergoing surgery or other invasive procedures. We included 63 randomized trials (4163 participants) published up to February 1, 2023. Seven trials were published after a 2017 Cochrane systematic review on this topic. There were 38 trials in cardiac surgery, 22 in noncardiac surgery, and 3 in non-surgical procedures. Meta-analyses demonstrated that desmopressin likely does not reduce the risk of receiving a red blood cell transfusion (25 trials, risk ratio [RR] 0.95, 95% confidence interval [CI] 0.86 to 1.05) and may not reduce the risk of reoperation due to bleeding (22 trials, RR 0.75, 95% CI 0.47 to 1.19) when compared to placebo or usual care. However, we demonstrated significant reductions in number of units of red blood cells transfused (25 trials, mean difference -0.55 units, 95% CI - 0.94 to - 0.15), total volume of blood loss (33 trials, standardized mean difference - 0.40 standard deviations; 95% CI - 0.56 to - 0.23), and the risk of bleeding events (2 trials, RR 0.45, 95% CI 0.24 to 0.84). The certainty of evidence of these findings was generally low. Desmopressin increased the risk of clinically significant hypotension that required intervention (19 trials, RR 2.15, 95% CI 1.36 to 3.41). Limited evidence suggests that tranexamic acid is more effective than desmopressin in reducing transfusion risk (3 trials, RR 2.38 favoring tranexamic acid, 95% CI 1.06 to 5.39) and total volume of blood loss (3 trials, mean difference 391.7 mL favoring tranexamic acid, 95% CI - 93.3 to 876.7 mL). No trials directly informed the safety and hemostatic efficacy of desmopressin in advanced kidney disease. In conclusion, desmopressin likely reduces periprocedural blood loss and the number of units of blood transfused in small trials with methodologic limitations. However, the risk of hypotension needs to be mitigated. Large trials should evaluate desmopressin alongside tranexamic acid and enroll patients with advanced kidney disease.
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Affiliation(s)
- Carol Wang
- Department of Medicine, Western University, London, ON, Canada
| | | | - Jeffy Yang
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Lily J Park
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Freeman Paczkowski
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Pavel S Roshanov
- Department of Medicine, Western University, London, ON, Canada.
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
- Population Health Research Institute, Hamilton, ON, Canada.
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Olaleye AA, Adebayo JA, Eze JN, Ajah LO, Anikwe CC, Egede JO, Ebere CI. Efficacy of Tranexamic Acid in Reducing Myomectomy-Associated Blood Loss among Patients with Uterine Myomas at Federal Teaching Hospital Abakaliki: A Randomized Control Trial. Int J Reprod Med 2024; 2024:2794052. [PMID: 38283394 PMCID: PMC10810692 DOI: 10.1155/2024/2794052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Background Myomectomy can be associated with life-threatening conditions such as bleeding. Excessive bleeding usually necessitates blood transfusion. Interventions to reduce bleeding during myomectomy will help reduce the need for blood transfusion with its associated complications. Tranexamic acid has been used to reduce bleeding in other surgical procedures, and its usage during myomectomy merits evaluation. Objective To assess the efficacy of tranexamic acid in reducing myomectomy-associated blood loss. Materials and Methods This is a prospective double-blinded randomized trial conducted on women who had abdominal myomectomy. Patients were randomized into two groups. The study group received perioperative intravenous tranexamic acid (TXA) while the control group received a placebo. Intraoperative blood loss was calculated by measuring the volume in the suction apparatus and weighing the surgical swabs. In addition, blood collected postoperatively from the wound drains and drapes were measured. Haemoglobin concentrations were determined preoperatively and on second postoperative day for all cases. Any adverse effect was noted in both groups. The data was processed using Epi Info software (7.2.1, CDC, Atlanta, Georgia). The relationships between categorical data were analyzed using X2 and Student's t-test to determine relationships between continuous variables, with a P value of 0.05 considered statistically significant, and correlation coefficients were calculated using Pearson's formula, and probability of 0.05 was set for statistical significance. Results Symptomatic uterine myomas constituted 17.3% of all gynaecological admissions and 21.3% of gynaecological operations at Federal Teaching Hospital Abakaliki. The mean intraoperative blood loss among patients that had perioperative tranexamic acid infusion was 413.6 ± 165.6 ml, while that of patients with placebo infusion was 713.6 ± 236.3 ml. Perioperative tranexamic acid infusion therefore reduced mean intraoperative blood loss by 300 ml, and this was statistically significant (SMD = -0.212, 95% CI: -403.932 to -196.067, P < 0.0001). Perioperative tranexamic acid reduced mean total blood loss by a value of 532.3 ml, and this is statistically significant (SMD = 30.622, 95% CI: 393.308 to 670.624, P < 0.0001). Tranexamic acid also improved postoperative haemoglobin concentration by 1.8 g/dl compared with placebo, and this is statistically significant (SMD = -0.122, 95% CI: 1.182 to 2.473, P < 0.0001). Tranexamic acid infusion decreased hospital stay by about 2 days, and this difference was statistically significant (SMD = -3.929, 95% CI: -3.018 to -0.983, P = 0.0003). There was no adverse drug reaction in the course of the study. Conclusion The use of tranexamic acid during myomectomy reduced intraoperative and postoperative blood loss. It is also associated with decreased hospital stay. This trial is registered with NCT04560465.
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Affiliation(s)
- Ayodele Adegbite Olaleye
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Joshua Adeniyi Adebayo
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Justus Ndulue Eze
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Leonard Ogbonna Ajah
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chidebe Christian Anikwe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - John O. Egede
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Chidi Ikenna Ebere
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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Mitha R, Colan JA, Hernandez-Rovira MA, Jawad-Makki MAH, Patel RP, Elsayed GA, Shaw JD, Okonkwo DO, Buell TJ, Hamilton DK, Agarwal N. Topical tranexamic acid (TXA) is non-inferior to intravenous TXA in adult spine surgery: a meta-analysis. Neurosurg Rev 2024; 47:48. [PMID: 38224410 DOI: 10.1007/s10143-023-02254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
Tranexamic acid (TXA) has long been utilized in spine surgery and can be administered through intravenous (IV) and topical routes. Although, topical and IV administration of TXA are both effective in decreasing blood loss during spine surgery, complications like deep vein thrombosis (DVT) and pulmonary embolism have been reported with the use of intravenous TXA (ivTXA). These potential complications may be mitigated through the use of topical TXA (tTXA). To assess optimal dosing protocols and efficacy of topical TXA in spine surgery, Embase, Ovid-MEDLINE, Scopus, Cochrane, and clinicaltrials.gov were queried for original research on the use of tTXA in adult patients undergoing spine surgery. Data parameters analyzed included blood loss, transfusion rate, thromboembolic, and other complications. Data was synthesized and confidence evaluated according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. Nineteen studies were included in the final analysis with 2197 patients. Of the 18 published studies, 9 (50%) displayed high levels of evidence. Topical TXA showed a trend towards a lower risk of transfusion and complications. Protocols that used 1g tTXA showed a significantly reduced risk for transfusion when compared to controls (risk ratio -1.05, 95% CI (-1.62, -0.48); P = 0.94, I2 = 0%). Complications associated with tTXA included DVTs and wound infections. Topical TXA was non-inferior to intravenous TXA with similar efficacy and complication profiles for bleeding control in spine surgery; however, more studies are needed to discern benefits and risks.
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Affiliation(s)
- Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Jhair Alejandro Colan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | | | - Mohamed-Ali H Jawad-Makki
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Rujvee P Patel
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Galal A Elsayed
- Och Spine, Weill Cornell Medicine, New-York Presbyterian Hospital, New York, NY, 10065, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
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Shibeko AM, Ilin IS, Podoplelova NA, Sulimov VB, Panteleev MA. Chemical Adjustment of Fibrinolysis. Pharmaceuticals (Basel) 2024; 17:92. [PMID: 38256925 PMCID: PMC10819531 DOI: 10.3390/ph17010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Fibrinolysis is the process of the fibrin-platelet clot dissolution initiated after bleeding has been stopped. It is regulated by a cascade of proteolytic enzymes with plasmin at its core. In pathological cases, the balance of normal clot formation and dissolution is replaced by a too rapid lysis, leading to bleeding, or an insufficient one, leading to an increased thrombotic risk. The only approved therapy for emergency thrombus lysis in ischemic stroke is recombinant tissue plasminogen activator, though streptokinase or urokinase-type plasminogen activators could be used for other conditions. Low molecular weight compounds are of great interest for long-term correction of fibrinolysis dysfunctions. Their areas of application might go beyond the hematology field because the regulation of fibrinolysis could be important in many conditions, such as fibrosis. They enhance or weaken fibrinolysis without significant effects on other components of hemostasis. Here we will describe and discuss the main classes of these substances and their mechanisms of action. We will also explore avenues of research for the development of new drugs, with a focus on the use of computational models in this field.
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Affiliation(s)
- Alexey M. Shibeko
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 109029 Moscow, Russia; (A.M.S.); (M.A.P.)
- National Medical Research Center of Pediatric Hematology, Oncology and Immunology Named after Dmitry Rogachev, 117197 Moscow, Russia
| | - Ivan S. Ilin
- Research Computing Center, Lomonosov Moscow State University, 119991 Moscow, Russia; (I.S.I.); (V.B.S.)
- Dimonta, Ltd., 117186 Moscow, Russia
| | - Nadezhda A. Podoplelova
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 109029 Moscow, Russia; (A.M.S.); (M.A.P.)
- National Medical Research Center of Pediatric Hematology, Oncology and Immunology Named after Dmitry Rogachev, 117197 Moscow, Russia
| | - Vladimir B. Sulimov
- Research Computing Center, Lomonosov Moscow State University, 119991 Moscow, Russia; (I.S.I.); (V.B.S.)
- Dimonta, Ltd., 117186 Moscow, Russia
| | - Mikhail A. Panteleev
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, 109029 Moscow, Russia; (A.M.S.); (M.A.P.)
- National Medical Research Center of Pediatric Hematology, Oncology and Immunology Named after Dmitry Rogachev, 117197 Moscow, Russia
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Wang X, Yang X, Sun Z, Guo X, Teng Y, Hou S, Shi J, Lv Q. Progress in injectable hydrogels for the treatment of incompressible bleeding: an update. Front Bioeng Biotechnol 2024; 11:1335211. [PMID: 38264581 PMCID: PMC10803650 DOI: 10.3389/fbioe.2023.1335211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Uncontrollable haemorrhage from deep, noncompressible wounds remains a persistent and intractable challenge, accounting for a very high proportion of deaths in both war and disaster situations. Recently, injectable hydrogels have been increasingly studied as potential haemostatic materials, highlighting their enormous potential for the management of noncompressible haemorrhages. In this review, we summarize haemostatic mechanisms, commonly used clinical haemostatic methods, and the research progress on injectable haemostatic hydrogels. We emphasize the current status of injectable hydrogels as haemostatic materials, including their physical and chemical properties, design strategy, haemostatic mechanisms, and application in various types of wounds. We discuss the advantages and disadvantages of injectable hydrogels as haemostatic materials, as well as the opportunities and challenges involved. Finally, we propose cutting-edge research avenues to address these challenges and opportunities, including the combination of injectable hydrogels with advanced materials and innovative strategies to increase their biocompatibility and tune their degradation profile. Surface modifications for promoting cell adhesion and proliferation, as well as the delivery of growth factors or other biologics for optimal wound healing, are also suggested. We believe that this paper will inform researchers about the current status of the use of injectable haemostatic hydrogels for noncompressible haemorrhage and spark new ideas for those striving to propel this field forward.
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Affiliation(s)
- Xiudan Wang
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Xinran Yang
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Zhiguang Sun
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Xiaoqin Guo
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Yanjiao Teng
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Shike Hou
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Jie Shi
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
| | - Qi Lv
- Institution of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Wenzhou, China
- Key Laboratory for Disaster Medicine Technology, Tianjin, China
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Czarnecka J, Neuschwander A, Aujoulat T, Balmier A, Belcour D, Boulanger B, Bourgain C, Caron M, Kiss G, Larghi M, Lebard C, Mellano V, Larson J, Megroian B, Lefrançois A, Fox S, Pollet A, Bourgoin P, Biland G, Braunberger E, Maccio G, Delmas B. Red Blood Cell Transfusion Requirements Before and After Implementation of a Perioperative Patient Blood Management Program in Adult Patients Undergoing Cardiac Surgery. A Before and After Observational Study. J Cardiothorac Vasc Anesth 2024; 38:73-79. [PMID: 37953174 DOI: 10.1053/j.jvca.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program. DESIGN Before-and-after observational study. SETTING Single-center French university teaching hospital. PARTICIPANTS Adult patients scheduled for cardiac surgery. INTERVENTIONS Perioperative patient blood management program including pre-, intra-, and postoperative interventions aimed at identifying and correcting anemia, minimizing blood loss during surgery, and optimizing coagulation. MEASUREMENTS AND MAIN RESULTS Four hundred thirty-four patients were included in the study from January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first 2 postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (p < 0.001). The application of a PBM program was associated with a reduction in perioperative RBC transfusion by multivariate analysis (odds ratio 0.55, 95% CI 0.36-0.85, p = 0.007), and was associated with a reduction in the median number of RBC units transfused within transfused patients (p = 0.025). These effects persisted at day 30 after surgery (p = 0.029). CONCLUSION A perioperative PBM program in adult patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, which persisted at day 30.
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Affiliation(s)
- Jeremie Czarnecka
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Arthur Neuschwander
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France.
| | - Thomas Aujoulat
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Adrien Balmier
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Dominique Belcour
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Boris Boulanger
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Caroline Bourgain
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Margot Caron
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Gabor Kiss
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Mathilde Larghi
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Christophe Lebard
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Vincent Mellano
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Jonathan Larson
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Blandine Megroian
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Anaelle Lefrançois
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Sylvain Fox
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Arnaud Pollet
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Pierre Bourgoin
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France; Department of anesthesiology, University Hospital, Nantes, France
| | - Guillaume Biland
- Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Eric Braunberger
- Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Guillaume Maccio
- French Blood Establishment, Felix Guyon University Hospital, Saint-Denis, Reunion, France
| | - Benjamin Delmas
- Department of Anaesthesia and Critical Care for Cardiovascular and Thoracic Surgery, Felix Guyon University Hospital, Saint-Denis, Reunion, France
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22
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Seretis K. Tranexamic Acid Irrigation in Liposuction: A Double-Blind, Half-Body, Randomized, and Placebo-Controlled Trial. Aesthetic Plast Surg 2024; 48:68-69. [PMID: 37821552 DOI: 10.1007/s00266-023-03684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Medical School, University of Ioannina, Leoforos St. Niarchou, 45500, Ioannina, Greece.
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23
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Brenner A, Shakur-Still H, Chaudhri R, Muganyizi P, Olayemi O, Arribas M, Kayani A, Javid K, Bello A, Roberts I. Tranexamic acid by the intramuscular or intravenous route for the prevention of postpartum haemorrhage in women at increased risk: a randomised placebo-controlled trial (I'M WOMAN). Trials 2023; 24:782. [PMID: 38044460 PMCID: PMC10694937 DOI: 10.1186/s13063-023-07687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) causes about 70,000 maternal deaths every year. Tranexamic acid (TXA) is a life-saving treatment for women with PPH. Intravenous (IV) TXA reduces deaths due to PPH by one-third when given within 3 h of childbirth. Because TXA is more effective when given early and PPH usually occurs soon after childbirth, giving TXA just before childbirth might prevent PPH. Although several randomised trials have examined TXA for PPH prevention, the results are inconclusive. Because PPH only affects a small proportion of births, we need good evidence on the balance of benefits and harms before using TXA to prevent PPH. TXA is usually given by slow IV injection. However, recent research shows that TXA is well tolerated and rapidly absorbed after intramuscular (IM) injection, achieving therapeutic blood levels within minutes of injection. METHODS The I'M WOMAN trial is an international, multicentre, three-arm, randomised, double-blind, placebo-controlled trial to assess the effects of IM and IV TXA for the prevention of PPH in women with one or more risk factors for PPH giving birth vaginally or by caesarean section. DISCUSSION The trial will provide evidence of the benefits and harms of TXA for PPH prevention and the effects of the IM and IV routes of administration. The IM route should be as effective as the IV route for preventing bleeding. There may be fewer side effects with IM TXA because peak blood concentrations are lower than with the IV route. IM TXA also has practical advantages as it is quicker and simpler to administer. By avoiding the need for IV line insertion and a slow IV injection, IM administration would free up overstretched midwives and doctors to focus on looking after the mother and baby and expand access to timely TXA treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT05562609. Registered on 3 October 2022. ISRCTN Registry ISRCTN12590098. Registered on 20 January 2023. Pan African Clinical Trial Registry PACTR202305473136570. Registered on 18 May 2023.
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Affiliation(s)
- Amy Brenner
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | | | | | | | - Monica Arribas
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aasia Kayani
- Shifa Tameer-E-Millat University, Islamabad, Pakistan
| | - Kiran Javid
- Shifa Tameer-E-Millat University, Islamabad, Pakistan
| | | | - Ian Roberts
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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24
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McDermott ER, Tennent DJ, Song DJ. Improving visualization in shoulder arthroscopy. Clin Shoulder Elb 2023; 26:455-461. [PMID: 37088880 DOI: 10.5397/cise.2022.01291] [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: 10/14/2022] [Accepted: 12/27/2022] [Indexed: 02/24/2023] Open
Abstract
Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.
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Affiliation(s)
- Emily R McDermott
- Department of Orthopedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - David J Tennent
- Department of Orthopedic Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
| | - Daniel J Song
- Department of Orthopedic Surgery, Evans Army Community Hospital, Fort Carson, CO, USA
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25
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Gammon R, Becker J, Cameron T, Eichbaum Q, Jindal A, Lamba DS, Nalezinski S, Rios J, Shaikh S, Shepherd J, Tanhehco YC. How do I manage a blood product shortage? Transfusion 2023; 63:2205-2213. [PMID: 37840217 DOI: 10.1111/trf.17572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients. STUDY DESIGN AND METHODS The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages. RESULTS Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks. DISCUSSION Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.
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Affiliation(s)
- Richard Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | - Joanne Becker
- Department of Pathology and Laboratory Medicine; Blood Bank and Therapeutic Apheresis Unit, Roswell Park Comprehensive Cancer Center, and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tracy Cameron
- Ontario Regional Blood Coordinating Network, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Quentin Eichbaum
- Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
| | - Aikaj Jindal
- Department of Transfusion Medicine, Mohandai Oswal Hospital, Ludhiana, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shaughn Nalezinski
- Department of Laboratory Medicine Transfusion Services, Concord Hospital, Concord, New Hampshire, USA
| | - Jorge Rios
- American Red Cross Blood Services, Dedham, Massachusetts, USA
| | - Salima Shaikh
- Vitalant, Northeast Division, Montvale, New Jersey, USA
| | - Janine Shepherd
- Transfusion Services Laboratory, Denver Health Hospital, Denver, Colorado, USA
| | - Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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26
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Huynh MNQ, Wong CR, McRae MC, Voineskos S, McRae MH. The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 152:993e-1004e. [PMID: 36995174 DOI: 10.1097/prs.0000000000010479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study was to determine the effect of TXA on postoperative blood loss in breast surgery. METHODS Searches of the PubMed, Ovid MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized controlled trials that administered TXA (topical or intravenously) in the context of breast surgery. Quality of studies were evaluated using the risk of bias in randomized trials tool and the risk of bias in nonrandomized studies of interventions tool. Data were pooled, and a meta-analysis was performed. RESULTS In total, seven studies were included, representing 1226 patients (TXA, 632 patients; control, 622 patients). TXA was administered as follows: topically (20 mL of 25 mg/mL TXA intraoperatively; n =258 patients), intravenously (1 to 3 g perioperatively; n = 743 patients), or both (1 to 3 g daily up to 5 days postoperatively; n = 253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI, 0.32 to 0.73), with no effect on drain output (mean difference, -84.12 mL; 95% CI, -206.53 to 38.29 mL), seroma formation (risk ratio, 0.92; 95% CI, 0.60 to 1.40), or infection rates (risk ratio, 1.01; 95% CI, 0.46 to 2.21). No adverse effects were reported. CONCLUSION The use of TXA in breast surgery is a safe and effective modality with low-level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.
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Affiliation(s)
| | - Chloe R Wong
- Michael G. DeGroote School of Medicine, McMaster University
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27
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Liu CH, Chang CH, Chang YH, Shih HN, Hu CC. Topical Fibrin Sealant (Tisseel@) Does Not Provide a Synergic Blood-Conservation Effect with Tranexamic Acid in Total Knee Arthroplasty-A Prospective Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2078. [PMID: 38138181 PMCID: PMC10744547 DOI: 10.3390/medicina59122078] [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: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The efficacy of tranexamic acid (TXA) in reducing perioperative blood loss during total knee arthroplasty (TKA) is well established. However, the potential synergistic blood-conservation effect of topical fibrin sealant (Tisseel@) remains unclear. This study aims to assess the effectiveness of the combination of Tisseel and TXA during TKA. Materials and Methods: A single-blinded, prospective, randomized controlled trial was conducted with 100 patients (100 knees) undergoing primary TKA. Participants were randomly assigned to either the TXA group (n = 50), receiving intravenous (IV) TXA, or the Tisseel@ + TXA group (n = 50), receiving intra-articular Tisseel@ combined with IV TXA. The primary outcomes included blood transfusion rate, decrease in Hb level, calculated blood loss, and estimated total postoperative blood loss. Secondary outcomes involved assessing clinical differences between the groups. Results: The transfusion rate was zero in both groups. The average estimated blood loss in the Tisseel@ + TXA group was 0.463 ± 0.2422 L, which was similar to that of the TXA group at 0.455 ± 0.2522 L. The total calculated blood loss in the Tisseel@ + TXA group was 0.259 ± 0.1 L, compared with the TXA group's 0.268 ± 0.108 L. The mean hemoglobin reduction in the first 24 h postoperatively was 1.57 ± 0.83 g/dL for the Tisseel@ + TXA group and 1.46 ± 0.82 g/dL for the TXA-only group. The reduction in blood loss in the topical Tisseel@ + TXA group was not significantly different from that achieved in the TXA-only group. The clinical results of TKA up to the 6-week follow-up were comparable between the groups. Conclusions: The combination of the topical fibrin sealant Tisseel@ and perioperative IV TXA administration, following the described protocol, demonstrated no significant synergistic blood-conservation effect in patients undergoing TKR.
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Affiliation(s)
- Chia-Hung Liu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Chih-Hsiang Chang
- Division of Joint Reconstruction, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.C.); (Y.-H.C.); (H.-N.S.)
| | - Yu-Han Chang
- Division of Joint Reconstruction, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.C.); (Y.-H.C.); (H.-N.S.)
| | - Hsin-Nung Shih
- Division of Joint Reconstruction, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.C.); (Y.-H.C.); (H.-N.S.)
| | - Chih-Chien Hu
- Division of Joint Reconstruction, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.C.); (Y.-H.C.); (H.-N.S.)
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28
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Erdoes G, Ahmed A, Kurz SD, Gerber D, Bolliger D. Perioperative hemostatic management of patients with type A aortic dissection. Front Cardiovasc Med 2023; 10:1294505. [PMID: 38054097 PMCID: PMC10694357 DOI: 10.3389/fcvm.2023.1294505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Coagulopathy is common in patients undergoing thoracic aortic repair for Stanford type A aortic dissection. Non-critical administration of blood products may adversely affect the outcome. It is therefore important to be familiar with the pathologic conditions that lead to coagulopathy in complex cardiac surgery. Adequate care of these patients includes the collection of the medical history regarding the use of antithrombotic and anticoagulant drugs, and a sophisticated diagnosis of the coagulopathy with viscoelastic testing and subsequently adapted coagulation therapy with labile and stable blood products. In addition to the above-mentioned measures, intraoperative blood conservation measures as well as good interdisciplinary coordination and communication contribute to a successful hemostatic management strategy.
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Affiliation(s)
- Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Aamer Ahmed
- Consultant Cardiothoracic Anaesthesiologist, Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Stephan D. Kurz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Daniel Gerber
- Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel Bolliger
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland
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29
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Sanchez Salcedo L, Manuel Baloira F, Adrover A, Bianco JC, Garcia Guzzo ME. Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication. A A Pract 2023; 17:e01730. [PMID: 37966353 DOI: 10.1213/xaa.0000000000001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Life-threatening anaphylaxis to tranexamic acid (TXA) is rare but critical in cardiac surgery. A 76-year-old patient undergoing elective ascending aorta replacement developed severe anaphylactic shock shortly after anesthesia induction. Subsequent skin prick tests confirmed a positive TXA reaction. While TXA and lysine derivatives were avoided in the second surgery, the patient experienced hyperfibrinolysis. Guided by rotational thromboelastometry, hemostatic therapy led to a successful outcome with minimal postoperative bleeding. This report emphasizes the importance of drug risk awareness and strategies to mitigate excessive bleeding in cardiac surgery.
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Affiliation(s)
- Lisa Sanchez Salcedo
- From the Department of Anesthesiology, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Buenos Aires, Argentina
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30
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Parmeshwar N, Mehta SR, Piper M. Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery. Ann Plast Surg 2023; 91:622-628. [PMID: 37405863 DOI: 10.1097/sap.0000000000003635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery. METHODS A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output. RESULTS Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003). CONCLUSIONS This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.
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Affiliation(s)
- Nisha Parmeshwar
- From the Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA
| | - Shayna R Mehta
- Wright State University, School of Medicine, Fairborn, OH
| | - Merisa Piper
- University of California San Francisco, San Francisco, CA
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31
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Song KH, Choi ES, Kim HY, Ahn KH, Kim HJ. Patient blood management to minimize transfusions during the postpartum period. Obstet Gynecol Sci 2023; 66:484-497. [PMID: 37551109 PMCID: PMC10663398 DOI: 10.5468/ogs.22288] [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: 10/30/2022] [Revised: 01/11/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Patient blood management is an evidence-based concept that seeks to minimize blood loss by maintaining adequate hemoglobin levels and optimizing hemostasis during surgery. Since the coronavirus disease 2019 pandemic, patient blood management has gained significance due to fewer blood donations and reduced amounts of blood stored for transfusion. Recently, the prevalence of postpartum hemorrhage (PPH), as well as the frequency of PPH-associated transfusions, has steadily increased. Therefore, proper blood transfusion is required to minimize PPH-associated complications while saving the patient's life. Several guidelines have attempted to apply this concept to minimize anemia during pregnancy and bleeding during delivery, prevent bleeding after delivery, and optimize recovery methods from anemia. This study systematically reviewed various guidelines to determine blood loss management in pregnant women.
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Affiliation(s)
- Kwan Heup Song
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Eun Saem Choi
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Hai Joong Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
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32
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Zhao M, Luo Y, Guo Z, Mu L, Lu J. The Efficacy of Tranexamic Acid in Craniomaxillofacial Surgery: A Systematic Review of Randomized Controlled Trials. J Craniofac Surg 2023; 34:2437-2441. [PMID: 37702525 DOI: 10.1097/scs.0000000000009724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/04/2023] [Indexed: 09/14/2023] Open
Abstract
This study aimed to evaluate the use of tranexamic acid in craniomaxillofacial surgery by meta-analysis. A comprehensive search was performed for randomized controlled trials (RCTs) mainly in 3 electronic databases (PubMed, EMBASE, and Cochrane Library) before August 2022. We collected and managed data for weighted mean difference of intraoperative blood loss, transfusion requirement, and operation time for the study. A total of 13 randomized controlled trials were included in the analysis. Compared with the control group, the tranexamic acid group showed a reduction in intraoperative blood loss of 198.67 ml (95% CI: -258.84 to -138.50 ml, P <0.00001), with blood transfusion requirement decreased by 7.77 ml/kg (95% CI: -10.80 to -4.73, P <0.0001) and less operation time (weighted mean difference= -10.39 min; 95% CI: -16.49 to -4.30 min, P =0.0008).
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Affiliation(s)
- Minghao Zhao
- Department of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuna Luo
- Department of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ziying Guo
- Department of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lin Mu
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jianjian Lu
- Department of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Acharya P, Amin A, Nallamotu S, Riaz CZ, Kuruba V, Senthilkumar V, Kune H, Bhatti SS, Sarlat IM, Krishna CV, Asif K, Nashwan AJ, Cheema HA. Prehospital tranexamic acid in trauma patients: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1284016. [PMID: 37928456 PMCID: PMC10623347 DOI: 10.3389/fmed.2023.1284016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background Prehospital tranexamic acid (TXA) may hold substantial benefits for trauma patients; however, the data underlying its efficacy and safety is scarce. Methods We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to July 2023 for all randomized controlled trials (RCTs) investigating prehospital TXA in trauma patients as compared to placebo or standard care without TXA. Data were pooled under a random-effects model using RevMan 5.4 with risk ratio (RR) and mean difference (MD) as the effect measures. Results A total of three RCTs were included in this review. Regarding the primary outcomes, prehospital TXA reduced the risk of 1-month mortality (RR 0.82, 95% CI 0.69-0.97) but did not increase survival with a favorable functional outcome at 6 months (RR 1.00, 95% CI 0.93-1.09). Prehospital TXA also reduced the risk of 24-h mortality but did not affect the risk of mortality due to bleeding and traumatic brain injury. There was no significant difference between the TXA and control groups in the incidence of RBC transfusion, and the number of ventilator- and ICU-free days. Prehospital TXA did not increase the risk of adverse events except for a small increase in the incidence of infections. Conclusion Prehospital TXA is useful in reducing mortality in trauma patients without a notable increase in the risk of adverse events. However, there was no effect on the 6-month favorable functional status. Further large-scale trials are required to validate the aforementioned findings. Systematic review registration PROSPERO (CRD42023451759).
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Affiliation(s)
- Pawan Acharya
- Department of Trauma and Orthopedics, Lister Hospital, Stevenage, United Kingdom
| | - Aamir Amin
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | | | | | - Venkataramana Kuruba
- Department of Orthopedics, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | | | - Harika Kune
- Kamineni Institute of Medical Sciences, Narketpally, Telangana, India
| | | | - Iván Moguel Sarlat
- Servicio de Ortopedia y Traumatología, Hospital General Dr Agustín O’Horán, Mérida, Yucatán, Mexico
| | | | - Kainat Asif
- Department of Medicine, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Huzaifa Ahmad Cheema
- Department of Emergency Medicine, King Edward Medical University, Lahore, Pakistan
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Hany A, Mansour A, Sediek M, Nabil M. Role of tranexamic acid-soaked gelatin sponge in minimizing rectus sheath hematoma after cesarean section in women treated with warfarin, a simple tool for high-risk cases, a randomized controlled trial. Eur J Med Res 2023; 28:448. [PMID: 37864195 PMCID: PMC10588007 DOI: 10.1186/s40001-023-01434-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND This study aims to illustrate the impact of applying the tranexamic acid impregnated in a gelatin sponge between the anterior rectus sheath and the Rectus Abdominis muscle during Cesarean section (CS) in minimizing rectus sheath hematoma (RHS) in women treated with Warfarin. METHODS A clinical trial was carried out on 63 pregnant women attended for elective CS, who on antenatal warfarin anticoagulation started from 13 weeks gestation to 36 weeks then shifted to low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH), and with an indication for postnatal warfarin anticoagulation. They were randomly assigned on the day of the scheduled CS into three equal groups (21 women for each). Group 1 had two pieces of gelatin sponges soaked with one ampoule of tranexamic acid. Group 2 had two pieces of gelatin sponges not soaked with tranexamic acid. Group 3 (control group) had no gelatin sponge applied. All patients underwent postoperative assessment done for hemoglobin (Hb), hematocrit (HCT), estimated blood loss (EBL), amount and nature of discharge collected from the sub-rectus drain, complications (RHS, wound infection, thromboembolism), need for re-operation, and need for blood transfusion. RESULTS Statistically significant differences were found between Group 1 and Group 2 regarding the postoperative Hb (10.66 ± 1.13 vs. 9.77 ± 0.69, P = 0.009), between Group 1 and Group 2 regarding the postoperative HCT (31.87 ± 3.59 vs. 28.54 ± 1.85, P = 0.001), between Group 1 and Group 2 regarding EBL (442.19 ± 244.46 vs. 744.38 ± 267.05, P = 0.003), between Group 1 and Group 3 regarding EBL (442.19 ± 244.46 vs. 664.29 ± 343.97, P = 0.040), and between Group 1 and Group 3 regarding the discharge amount from the sub rectus drain (190.48 ± 100.77 vs. 307.14 ± 127.76, P = 0.004). CONCLUSION Tranexamic acid-soaked gelatin sponges are safe and effective in reducing postoperative drainage and EBL. CLINICAL TRIAL REGISTRATION At ClinicalTrials.gov in June 2022 (NCT05439694).
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Affiliation(s)
- Ayman Hany
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
| | - Ayman Mansour
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt.
| | - Mona Sediek
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
| | - Mohamed Nabil
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
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Al-Hashimi M, Kaur P, Charles W, Bhasta M, Nahai F, Khajuria A. A Systematic Review of the Efficacy and Safety of Tranexamic Acid in Facelift Surgery. Aesthet Surg J 2023; 43:1211-1218. [PMID: 37402636 DOI: 10.1093/asj/sjad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/06/2023] Open
Abstract
Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. The aim of this review was to robustly evaluate the quality of available evidence on the efficacy and safety of TXA use in facelift surgery. We searched the MEDLINE (National Institutes of Health, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), CINAHL (EBSCO Information Services, Ipswich, MA), Cochrane Central Register of Controlled Trials (CENTRAL; Wiley, Hoboken, NJ), Google Scholar (Alphabet Inc. Mountain View, CA), Science Citation Index (Clarivate, London, UK), and Latin American and Caribbean Center on Health Sciences Information (LILACS; São Paulo, Brazil) databases for randomized controlled trials (RCTs) and observational studies. Primary outcomes were blood loss, postoperative hematoma, ecchymosis, and swelling, in addition to technical considerations and complications. We assessed review quality with the AMSTAR 2 tool, study quality with Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE) tool, and the risk of bias with Cochrane's RoB 2.0 tool for RCTs and ROBINS-I for nonrandomized studies. Of the 368 articles, a total of 3 studies including 150 patients met the inclusion criteria. The RCT reported a significant reduction in postoperative serosanguineous collections in the TXA group (P < .01), and in surgeon-rated postoperative ecchymosis and bruising. The prospective cohort study reported reduced drainage output in first 24 hours in the TXA group (P < .01). The retrospective cohort study reported lower intraoperative blood loss, mean postoperative day 1 drain output, percentage of drain removal on postoperative day 1, and number of days to drain removal in the TXA group (all P < .01). The quality of studies was moderate, and this review was the highest rated compared to previous reviews, as per the AMSTAR 2 tool. Based on limited literature, TXA improves clinical outcomes regardless of the route of administration. Topical TXA is an emerging route, expediting drain removal and reducing blood loss. Future Level I high-quality studies are required.
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Hess MC, Andrews NA, Crowley B, Singh NP, Howie C, McGwin G, Siegel H. Intravenous tranexamic acid decreases intraoperative transfusion requirements and does not increase incidence of symptomatic venous thromboembolic events in musculoskeletal sarcoma surgery. Surg Oncol 2023; 50:101989. [PMID: 37717375 DOI: 10.1016/j.suronc.2023.101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Tranexamic acid (TXA) is poorly studied in patients with bone and musculoskeletal sarcoma due to perceived increased risk of venous thromboembolism (VTE). This study aims to assess the safety and efficacy of intravenous (IV) TXA for patients undergoing surgical resection of primary bone or soft-tissue sarcoma. METHODS A retrospective, single center review of adult patients with pelvic or extremity sarcoma who underwent surgical resections between January 2005 and March 2020 was performed. Patients between 2005 and 2012 were included as a historical comparison prior to the routine use of IV TXA for all sarcoma resections at our institution. RESULTS Thirty-nine non-TXA and 59 TXA resections were identified. Two non-TXA patients experienced symptomatic pulmonary embolism compared to zero VTEs amongst TXA patients. IV TXA administered at any dose significantly reduced the probability of intraoperative transfusion (p = 0.003) and the median units of blood transfused at the time of any perioperative transfusion (p = 0.007). Intraoperative times were significantly shorter for TXA patients (128 vs 190 min; p = 0.004). A subset of patients who underwent wide resection with endoprosthetic reconstruction and received TXA similarly showed decreased requirement for intraoperative transfusion (p = 0.014) and decreased procedure times (p = 0.009). CONCLUSIONS During sarcoma resection, at least 1 g of IV TXA can safely decrease the need for any intraoperative transfusion and the median number of PRBCs transfused by 2 units when any perioperative transfusion is given.
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Affiliation(s)
- Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon Crowley
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington D.C, USA
| | - Nikhi P Singh
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Cole Howie
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herrick Siegel
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Lam T, Medcalf RL, Cloud GC, Myles PS, Keragala CB. Tranexamic acid for haemostasis and beyond: does dose matter? Thromb J 2023; 21:94. [PMID: 37700271 PMCID: PMC10496216 DOI: 10.1186/s12959-023-00540-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
Tranexamic acid (TXA) is a widely used antifibrinolytic agent that has been used since the 1960's to reduce blood loss in various conditions. TXA is a lysine analogue that competes for the lysine binding sites in plasminogen and tissue-type plasminogen activator impairing its interaction with the exposed lysine residues on the fibrin surface. The presence of TXA therefore, impairs the plasminogen and tPA engagement and subsequent plasmin generation on the fibrin surface, protecting fibrin clot from proteolytic degradation. However, critical lysine binding sites for plasmin(ogen) also exist on other proteins and on various cell-surface receptors allowing plasmin to exert potent effects on other targets that are unrelated to classical fibrinolysis, notably in relation to immunity and inflammation. Indeed, TXA was reported to significantly reduce post-surgical infection rates in patients after cardiac surgery unrelated to its haemostatic effects. This has provided an impetus to consider TXA in other indications beyond inhibition of fibrinolysis. While there is extensive literature on the optimal dosage of TXA to reduce bleeding rates and transfusion needs, it remains to be determined if these dosages also apply to blocking the non-canonical effects of plasmin.
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Affiliation(s)
- Tammy Lam
- Australian Centre for Blood Diseases, Monash AMREP Building, Monash University, Level 1 Walkway, Via The Alfred Centre, 99 Commercial Rd, Melbourne, 3004, Australia
| | - Robert L Medcalf
- Australian Centre for Blood Diseases, Monash AMREP Building, Monash University, Level 1 Walkway, Via The Alfred Centre, 99 Commercial Rd, Melbourne, 3004, Australia
| | - Geoffrey C Cloud
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne VIC, Australia
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne VIC, Australia
| | - Charithani B Keragala
- Australian Centre for Blood Diseases, Monash AMREP Building, Monash University, Level 1 Walkway, Via The Alfred Centre, 99 Commercial Rd, Melbourne, 3004, Australia.
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38
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Neel OF, AlKhashan R, AlFadhel EA, Al-Terkawi RA, Mortada H. Use of Tranexamic Acid in Aesthetic Surgery: A Retrospective Comparative Study of Outcomes and Complications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5229. [PMID: 37662475 PMCID: PMC10473321 DOI: 10.1097/gox.0000000000005229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023]
Abstract
Background Bleeding is a potential complication of aesthetic surgery. Surgeons have adhered to the principle of minimizing blood loss. Tranexamic acid (TXA) is an antifibrinolytic medication capable of reducing bleeding. This study aimed to investigate TXA and its effect on complications and overall outcomes in aesthetic surgery patients. Methods This retrospective chart review of patients undergoing various aesthetic procedures between 2019 and 2022 was conducted in Riyadh, Saudi Arabia. Preoperative and postoperative hemoglobin levels, blood transfusions, and complications were the primary outcomes. Furthermore, the predictors of giving TXA were studied. Results In total, 435 patients were included in the study. TXA was administered to 181 patients (41.6%). Significantly higher proportions of patients who received TXA underwent trunk aesthetic surgery (P < 0.001), and those who received TXA underwent combined procedures more frequently than non-users (P < 0.001). The mean operative time and length of hospital stay were significantly longer among patients who did not receive TXA (P < 0.001, and P < 0.001, respectively). Most predictors for using TXA were significantly associated with performing liposuction (OR = 5.5), trunk aesthetic surgery (OR = 4.9), and undergoing combined procedures (OR = 2.7). No significant difference was noted in the rate of complications between the two cohorts. Conclusions Although our data show improvement in patient outcomes in multiple aspects, the heterogeneity of our cohort makes us unable to draw definite conclusions to recommend the use of TXA in aesthetic surgery. Thus, a randomized controlled trial is necessary to support the findings of this study.
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Affiliation(s)
- Omar Fouda Neel
- From Division of Plastic Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
- Division of Plastic Surgery, Department of Surgery, McGill University, Montreal, Canada
| | | | | | | | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
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Callum J, Evans CCD, Barkun A, Karkouti K. Prise en charge non chirurgicale de l’hémorragie majeure. CMAJ 2023; 195:E1126-E1135. [PMID: 37640404 PMCID: PMC10462413 DOI: 10.1503/cmaj.221731-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Jeannie Callum
- Département de pathologie et de médecine moléculaire (Callum), Centre des sciences de la santé Kingston et Université Queen's; Département de médecine d'urgence et Division de traumatologie (Evans), Centre des sciences de la santé de Kingston, Kingston, Ont.; Département de médecine, Université McGill et Centre universitaire de santé McGill (Barkun), Montréal, Qc; Département d'anesthésiologie et de traitement de la douleur (Karkouti), Hôpital général de Toronto et Université de Toronto, Toronto, Ont.
| | - Christopher C D Evans
- Département de pathologie et de médecine moléculaire (Callum), Centre des sciences de la santé Kingston et Université Queen's; Département de médecine d'urgence et Division de traumatologie (Evans), Centre des sciences de la santé de Kingston, Kingston, Ont.; Département de médecine, Université McGill et Centre universitaire de santé McGill (Barkun), Montréal, Qc; Département d'anesthésiologie et de traitement de la douleur (Karkouti), Hôpital général de Toronto et Université de Toronto, Toronto, Ont
| | - Alan Barkun
- Département de pathologie et de médecine moléculaire (Callum), Centre des sciences de la santé Kingston et Université Queen's; Département de médecine d'urgence et Division de traumatologie (Evans), Centre des sciences de la santé de Kingston, Kingston, Ont.; Département de médecine, Université McGill et Centre universitaire de santé McGill (Barkun), Montréal, Qc; Département d'anesthésiologie et de traitement de la douleur (Karkouti), Hôpital général de Toronto et Université de Toronto, Toronto, Ont
| | - Keyvan Karkouti
- Département de pathologie et de médecine moléculaire (Callum), Centre des sciences de la santé Kingston et Université Queen's; Département de médecine d'urgence et Division de traumatologie (Evans), Centre des sciences de la santé de Kingston, Kingston, Ont.; Département de médecine, Université McGill et Centre universitaire de santé McGill (Barkun), Montréal, Qc; Département d'anesthésiologie et de traitement de la douleur (Karkouti), Hôpital général de Toronto et Université de Toronto, Toronto, Ont
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Binyamin Y, Frenkel A, Gruzman I, Lerman S, Bichovsky Y, Zlotnik A, Stav MY, Erez O, Orbach-Zinger S. Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections. J Clin Med 2023; 12:5253. [PMID: 37629295 PMCID: PMC10455366 DOI: 10.3390/jcm12165253] [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: 07/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Amit Frenkel
- General Intensive Care Department, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.F.); (Y.B.)
| | - Igor Gruzman
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Sofia Lerman
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Yoav Bichovsky
- General Intensive Care Department, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.F.); (Y.B.)
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (I.G.); (A.Z.)
| | - Michael Y. Stav
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sakler Medical School, Tel Aviv University, Tel Aviv 6423906, Israel; (M.Y.S.); (S.O.-Z.)
| | - Offer Erez
- Division of Obstetrics and Gynecology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel;
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Rabin Medical Center Associated with Sakler Medical School, Tel Aviv University, Tel Aviv 6423906, Israel; (M.Y.S.); (S.O.-Z.)
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Shaker EH, Soliman AM, Hussein AF, Fayek ES, Elrawas MM. Evaluating the Efficacy and Safety of a Single-Dose Tranexamic Acid in Reducing Blood Loss During Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy: A Randomized Comparative Pilot Study. Anesth Pain Med 2023; 13:e136578. [PMID: 38024001 PMCID: PMC10664172 DOI: 10.5812/aapm-136578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hyperthermic intraperitoneal chemotherapy (HIPEC), following cytoreductive surgery (CRS), is a lengthy procedure, usually associated with considerable bleeding due to the extensive nature of surgery. Various techniques have been used to decrease blood transfusion requirements. Objectives This study aimed to evaluate the possible advantage of a single dose of tranexamic acid (TA) in such surgeries. Methods In this randomized comparative pilot study, 60 patients scheduled to undergo CRS followed by HIPEC were randomly assigned to 2 equal groups: group 1 (TA group) that received 10 mg/kg of TA in 100 mL of 0.9% NaCl over 20 minutes after the induction of anesthesia and before surgical incision, and group 2 (control group) that received a placebo of 100 mL of 0.9% NaCl during the same time interval. The primary endpoint was the blood loss volume. The secondary endpoints were the number of patients requiring transfusion and the occurrence of any postoperative thrombotic events 30 days after surgery. Serum creatinine levels were measured before the operation and on postoperative days 1, 3, and 5. Intraoperative and first 24 hours urine outputs were also recorded. The levels of hemoglobin (Hb) were measured before the operation, immediately after the operation, and 5 days postoperatively. Results Compared to the control group, the TA group exhibited lower intraoperative blood loss, as well as lower blood loss on postoperative day 1 and in total blood loss (P = 0.006, 0.035, and 0.001, respectively). However, the blood loss on the remaining postoperative days was comparable between both groups. Intraoperative blood transfusion requirements were lower in the TA group (P = 0.032) than in the control group. The total number of units of blood and plasma transfused was also lower in the TA group both intra and postoperatively (0.007, 0.40, and 0.032, 0.008, respectively) than in the control group. Hemoglobin levels, serum creatinine levels, and urine outputs during the first 24 hours postoperatively were comparable between the 2 groups. The thromboembolic events within 30 days were also comparable between the 2 groups. Conclusions Administering a single dose of TA between the induction of anesthesia and the surgical incision may reduce blood loss and transfusion rates in CRS followed by HIPEC without causing significant adverse effects. It is a promising approach in surgeries where massive blood loss is expected shortly after anesthesia induction. This can minimize the drawbacks of repeated blood transfusions during and after the operation without causing significant adverse effects. Besides reducing the need for repeated blood transfusions, it would also reduce the costs of blood/blood products and the risks of transfusion.
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Affiliation(s)
- Ehab Hanafy Shaker
- Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Mohamed Soliman
- Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Fahmy Hussein
- Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ehab Samy Fayek
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mai Mohamed Elrawas
- Department of Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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Lin YH, Lee KC, Hsu CC, Chen KT. Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34146. [PMID: 37352047 PMCID: PMC10289517 DOI: 10.1097/md.0000000000034146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND This meta-analysis compared the effects of intravenous Tranexamic acid (TXA) and a placebo on hemostasis, hospital course, and complications in adult patients undergoing various urologic surgeries. METHODS The literature was extensively searched using various databases. The primary outcomes were standardized mean differences (SMDs) of intraoperative blood loss and odds ratios (ORs) of necessary blood product transfusion. The secondary outcomes included SMDs of operative time, SMDs of decreased hemoglobulin levels at 24 hours after surgery, and ORs of thromboembolic events. RESULTS The meta-analysis included 13 randomized controlled trials (RCT) comprising 1814 participants in total. The SMD of intraoperative blood loss for TXA versus placebo was -0.705 (95% confidence interval [CI]: -1.113 to -0.297). The pooled ORs of transfusion in the TXA group compared with the placebo group was 0.426 (95% CI: 0.290-0.625). These findings indicated a significantly lower intraoperative blood loss and a reduced need for transfusion following intravenous TXA. The pooled ORs of thromboembolic events in the TXA group compared with the placebo group was 0.664 (95% CI: 0.146-3.024). CONCLUSIONS Intravenous TXA can reduce intraoperative blood loss, decrease the need for transfusion, and shorten operative time, and it does not increase the risk of thromboembolic events.
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Affiliation(s)
- Yu-Hui Lin
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chang Lee
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
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Lewis SR, Pritchard MW, Estcourt LJ, Stanworth SJ, Griffin XL. Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews. Cochrane Database Syst Rev 2023; 6:CD013737. [PMID: 37294864 PMCID: PMC10249061 DOI: 10.1002/14651858.cd013737.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Following hip fracture, people sustain an acute blood loss caused by the injury and subsequent surgery. Because the majority of hip fractures occur in older adults, blood loss may be compounded by pre-existing anaemia. Allogenic blood transfusions (ABT) may be given before, during, and after surgery to correct chronic anaemia or acute blood loss. However, there is uncertainty about the benefit-risk ratio for ABT. This is a potentially scarce resource, with availability of blood products sometimes uncertain. Other strategies from Patient Blood Management may prevent or minimise blood loss and avoid administration of ABT. OBJECTIVES To summarise the evidence from Cochrane Reviews and other systematic reviews of randomised or quasi-randomised trials evaluating the effects of pharmacological and non-pharmacological interventions, administered perioperatively, on reducing blood loss, anaemia, and the need for ABT in adults undergoing hip fracture surgery. METHODS In January 2022, we searched the Cochrane Library, MEDLINE, Embase, and five other databases for systematic reviews of randomised controlled trials (RCTs) of interventions given to prevent or minimise blood loss, treat the effects of anaemia, and reduce the need for ABT, in adults undergoing hip fracture surgery. We searched for pharmacological interventions (fibrinogen, factor VIIa and factor XIII, desmopressin, antifibrinolytics, fibrin and non-fibrin sealants and glue, agents to reverse the effects of anticoagulants, erythropoiesis agents, iron, vitamin B12, and folate replacement therapy) and non-pharmacological interventions (surgical approaches to reduce or manage blood loss, intraoperative cell salvage and autologous blood transfusion, temperature management, and oxygen therapy). We used Cochrane methodology, and assessed the methodological quality of included reviews using AMSTAR 2. We assessed the degree of overlap of RCTs between reviews. Because overlap was very high, we used a hierarchical approach to select reviews from which to report data; we compared the findings of selected reviews with findings from the other reviews. Outcomes were: number of people requiring ABT, volume of transfused blood (measured as units of packed red blood cells (PRC)), postoperative delirium, adverse events, activities of daily living (ADL), health-related quality of life (HRQoL), and mortality. MAIN RESULTS We found 26 systematic reviews including 36 RCTs (3923 participants), which only evaluated tranexamic acid and iron. We found no reviews of other pharmacological interventions or any non-pharmacological interventions. Tranexamic acid (17 reviews, 29 eligible RCTs) We selected reviews with the most recent search date, and which included data for the most outcomes. The methodological quality of these reviews was low. However, the findings were largely consistent across reviews. One review included 24 RCTs, with participants who had internal fixation or arthroplasty for different types of hip fracture. Tranexamic acid was given intravenously or topically during the perioperative period. In this review, based on a control group risk of 451 people per 1000, 194 fewer people per 1000 probably require ABT after receiving tranexamic acid (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.46 to 0.68; 21 studies, 2148 participants; moderate-certainty evidence). We downgraded the certainty for possible publication bias. Review authors found that there was probably little or no difference in the risks of adverse events, reported as deep vein thrombosis (RR 1.16, 95% CI 0.74 to 1.81; 22 studies), pulmonary embolism (RR 1.01, 95% CI 0.36 to 2.86; 9 studies), myocardial infarction (RR 1.00, 95% CI 0.23 to 4.33; 8 studies), cerebrovascular accident (RR 1.45, 95% CI 0.56 to 3.70; 8 studies), or death (RR 1.01, 95% CI 0.70 to 1.46; 10 studies). We judged evidence from these outcomes to be moderate certainty, downgraded for imprecision. Another review, with a similarly broad inclusion criteria, included 10 studies, and found that tranexamic acid probably reduces the volume of transfused PRC (0.53 fewer units, 95% CI 0.27 to 0.80; 7 studies, 813 participants; moderate-certainty evidence). We downgraded the certainty because of unexplained high levels of statistical heterogeneity. No reviews reported outcomes of postoperative delirium, ADL, or HRQoL. Iron (9 reviews, 7 eligible RCTs) Whilst all reviews included studies in hip fracture populations, most also included other surgical populations. The most current, direct evidence was reported in two RCTs, with 403 participants with hip fracture; iron was given intravenously, starting preoperatively. This review did not include evidence for iron with erythropoietin. The methodological quality of this review was low. In this review, there was low-certainty evidence from two studies (403 participants) that there may be little or no difference according to whether intravenous iron was given in: the number of people who required ABT (RR 0.90, 95% CI 0.73 to 1.11), the volume of transfused blood (MD -0.07 units of PRC, 95% CI -0.31 to 0.17), infection (RR 0.99, 95% CI 0.55 to 1.80), or mortality within 30 days (RR 1.06, 95% CI 0.53 to 2.13). There may be little or no difference in delirium (25 events in the iron group compared to 26 events in control group; 1 study, 303 participants; low-certainty evidence). We are very unsure whether there was any difference in HRQoL, since it was reported without an effect estimate. The findings were largely consistent across reviews. We downgraded the evidence for imprecision, because studies included few participants, and the wide CIs indicated possible benefit and harm. No reviews reported outcomes of cognitive dysfunction, ADL, or HRQoL. AUTHORS' CONCLUSIONS Tranexamic acid probably reduces the need for ABT in adults undergoing hip fracture surgery, and there is probably little or no difference in adverse events. For iron, there may be little or no difference in overall clinical effects, but this finding is limited by evidence from only a few small studies. Reviews of these treatments did not adequately include patient-reported outcome measures (PROMS), and evidence for their effectiveness remains incomplete. We were unable to effectively explore the impact of timing and route of administration between reviews. A lack of systematic reviews for other types of pharmacological or any non-pharmacological interventions to reduce the need for ABT indicates a need for further evidence syntheses to explore this. Methodologically sound evidence syntheses should include PROMS within four months of surgery.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Simon J Stanworth
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Trauma & Orthopaedics Surgery Group, Blizard Institute, Queen Mary University of London, London, UK
- The Royal London Hospital Barts Health NHS Trust, London, UK
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Yang F, Wang H, Shen M. Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:420. [PMID: 37280562 DOI: 10.1186/s12884-023-05753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is one of the important risk factors leading to maternal mortality and intervention is essential. Oxytocin therapy is widely used clinically, but the effect is unsatisfactory. The efficacy of tranexamic acid (TXA) in hemostasis is notable, whereas its use in preventing PPH warrants exploration. AIMS To evaluate the effect of prophylactic administration of TXA on perioperative blood loss in women undergoing cesarean section by systematic review and meta-analysis of published studies. METHODS Bibliographic databases were screened from their inception to December 2022 to retrieve relevant studies. Study outcomes including blood loss during cesarean section, 2-h postpartum blood loss, total blood loss (during cesarean section and 2-h postpartum), and 6-h postpartum, as well as hemoglobin changes were extracted and compared. RESULTS A total of 21 studies, nine randomized clinical trials and 12 cohort studies, involving 1896 patients given TXA prophylactically and 1909 patients given placebo or no treatment, were analyzed. Compared with the control group, the preoperative prophylactic intravenous administration of TXA significantly reduced the intraoperative (RCT: P < 0.00001, cohort studies: P < 0.00001), 2-h postpartum (RCT: P = 0.02, cohort studies: P < 0.00001) and total blood loss (RCT: P < 0.00001, cohort studies: P = 0.0002), and reduced the decline in hemoglobin (RCT: P < 0.00001, cohort studies: P = 0.0001), but did not significantly affect blood loss at 6-h postpartum (P = 0.05). CONCLUSION Prophylactic intravenous TXA before cesarean section is helpful in preventing perioperative bleeding in women. TRIAL REGISTRATION http://www.crd.york.ac.uk/PROSPERO , identifier: CRD 42022363450.
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Affiliation(s)
- Fan Yang
- Department of Intensive Care Unit, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China
| | - Han Wang
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China
| | - Mengdie Shen
- Department of Internal Medicine, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China.
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Dua M, Bhardwaj V, Dahiya M. Is Combining Two Different Routes of TXA Administration an Effective Blood Conserving Strategy for Total Knee Arthroplasty. Indian J Orthop 2023; 57:868-875. [PMID: 37214364 PMCID: PMC10192494 DOI: 10.1007/s43465-023-00875-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
Aim To evaluate the efficacy of combined use of pre-operative oral and post-operative intravenous (IV) tranexamic acid (TXA) as an effective blood conserving regimen in total knee arthroplasty (TKA) and compare its outcome with other modes of TXA administration. Patients and Methods A prospective observational study was conducted on 25 patients with osteoarthritis knee undergoing TKA. Patients were given 1950 mg of oral TXA pre-operatively and 15 mg/kg of IV TXA post-operatively before tourniquet deflation. The outcome of the study in terms of peri-operative (intra-operative and post-operative) blood loss estimation, drain output, percentage fall in haemoglobin, and knee HSS scores pre-operatively and on subsequent follow-up were compared with the outcome of previous studies conducted in the same institution with intra-operative topical TXA administration, pre-operative oral TXA administration and without TXA administration. Results The mean drain volume was 307.30 ± 148.00 ml and 22 (88%) patients had a drain volume less than 500 ml. The mean post-operative haemoglobin value was 10.53 ± 1.75 g/dl. It was observed that 18 (72%) of patients had up to 15% fall in haemoglobin. The mean percentage fall was 11.92%. In this study, 22 (88%) patients did not require any blood transfusion. Mean blood loss was 369.6 ± 159.96 ml. Maximum patients had less than 500 ml blood loss. No incidence of implant loosening, infection or wound gaping, clinically evident DVT/pulmonary thromboembolism was observed in the present study. We analysed total modified HSS knee score from pre-operative to 6 months follow-up using multi-group repeated measures analysis of variance (ANOVA), the difference in total modified HSS knee score between all the duration was observed to be highly significant (p < 0.001). Discussion Combined administration of pre-operative oral and post-operative IV TXA is a safe and effective blood-conserving strategy in patients undergoing TKA along with the use of tourniquet. The outcome in terms of post-operative blood loss and drain output and the knee HSS score is comparable to the other modes of administration. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00875-w.
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Affiliation(s)
- Mohit Dua
- Department of Sports Medicine, Pt. B. D. Sharma PGIMS, 11J/21, Medical Enclave, Rohtak, Haryana 124001 India
| | - Vikas Bhardwaj
- Department of Orthopaedic Surgery, Pt. B. D. Sharma PGIMS, Rohtak, Haryana 124001 India
| | - Monika Dahiya
- Department of Ophthalmology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana 124001 India
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Ker K, Shakur-Still H, Sentilhes L, Pacheco LD, Saade G, Deneux-Tharaux C, Brenner A, Mansukhani R, Ageron FX, Prowse D, Chaudhri R, Olayemi O, Roberts I. Tranexamic acid for the prevention of postpartum bleeding: Protocol for a systematic review and individual patient data meta-analysis. Gates Open Res 2023; 7:3. [PMID: 37601311 PMCID: PMC10439279 DOI: 10.12688/gatesopenres.13747.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 09/05/2023] Open
Abstract
Tranexamic acid (TXA) reduces the risk of death and is recommended as a treatment for women with severe postpartum bleeding. There is hope that giving TXA shortly before or immediately after birth could prevent postpartum bleeding. Extending the use of TXA to prevent harmful postpartum bleeding could improve outcomes for millions of women; however we must carefully consider the balance of benefits and potential harms. This article describes the protocol for a systematic review and individual patient data (IPD) meta-analysis to assess the effectiveness and safety of TXA for preventing postpartum bleeding in all women giving birth, and to explore how the effects vary by underlying risk and other patient characteristics. Methods: We will search for prospectively registered, randomised controlled trials involving 500 patients or more assessing the effects of TXA in women giving birth. Two authors will extract data and assess risk of bias. IPD data will be sought from eligible trials. Primary outcomes will be life-threatening bleeding and thromboembolic events. We will use a one-stage model to analyse the data. Subgroup analyses will be conducted to explore whether the effectiveness and safety of TXA varies by underlying risk, type birth, maternal haemoglobin (Hb), and timing of TXA. This protocol is registered on PROSPERO (CRD42022345775). Conclusions: This systematic review and IPD meta-analysis will address important clinical questions about the effectiveness and safety of the use of TXA for the prevention of postpartum bleeding that cannot be answered reliably using aggregate data and will inform the decision of who to treat. PROSPERO registration: CRD42022345775 Keywords Anti-fibrinolytics; Tranexamic acid; childbirth; postpartum haemorrhage; meta-analysis.
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Affiliation(s)
- The Anti-fibrinolytics Trialists Collaborators – Obstetric Trialists Group
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Department of Obstetrics & Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology & Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Rawalpindi Medical College, Rawalpindi, Pakistan
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Katharine Ker
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Haleema Shakur-Still
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Loïc Sentilhes
- Department of Obstetrics & Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Luis D. Pacheco
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Catherine Deneux-Tharaux
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology & Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Amy Brenner
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Raoul Mansukhani
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - François-Xavier Ageron
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Danielle Prowse
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | - Ian Roberts
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Ker K, Shakur-Still H, Sentilhes L, Pacheco LD, Saade G, Deneux-Tharaux C, Brenner A, Mansukhani R, Ageron FX, Prowse D, Chaudhri R, Olayemi O, Roberts I. Tranexamic acid for the prevention of postpartum bleeding: Protocol for a systematic review and individual patient data meta-analysis. Gates Open Res 2023; 7:3. [PMID: 37601311 PMCID: PMC10439279 DOI: 10.12688/gatesopenres.13747.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) reduces the risk of death and is recommended as a treatment for women with severe postpartum bleeding. There is hope that giving TXA shortly before or immediately after birth could prevent postpartum bleeding. Extending the use of TXA to prevent harmful postpartum bleeding could improve outcomes for millions of women; however we must carefully consider the balance of benefits and potential harms. This article describes the protocol for a systematic review and individual patient data (IPD) meta-analysis to assess the effectiveness and safety of TXA for preventing postpartum bleeding in all women giving birth, and to explore how the effects vary by underlying risk and other patient characteristics. Methods: We will search for prospectively registered, randomised controlled trials involving 500 patients or more assessing the effects of TXA in women giving birth. Two authors will extract data and assess risk of bias. IPD data will be sought from eligible trials. Primary outcomes will be life-threatening bleeding and thromboembolic events. We will use a one-stage model to analyse the data. Subgroup analyses will be conducted to explore whether the effectiveness and safety of TXA varies by underlying risk, type birth, maternal haemoglobin (Hb), and timing of TXA. This protocol is registered on PROSPERO (CRD42022345775). Conclusions: This systematic review and IPD meta-analysis will address important clinical questions about the effectiveness and safety of the use of TXA for the prevention of postpartum bleeding that cannot be answered reliably using aggregate data and will inform the decision of who to treat. PROSPERO registration: CRD42022345775 Keywords Anti-fibrinolytics; Tranexamic acid; childbirth; postpartum haemorrhage; meta-analysis.
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Affiliation(s)
- The Anti-fibrinolytics Trialists Collaborators – Obstetric Trialists Group
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Department of Obstetrics & Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology & Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Rawalpindi Medical College, Rawalpindi, Pakistan
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Katharine Ker
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Haleema Shakur-Still
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Loïc Sentilhes
- Department of Obstetrics & Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Luis D. Pacheco
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Catherine Deneux-Tharaux
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology & Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Amy Brenner
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Raoul Mansukhani
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - François-Xavier Ageron
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Danielle Prowse
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | - Ian Roberts
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Clynch AL, Gillespie CS, Richardson GE, Mustafa MA, Islim AI, Keshwara SM, Bakhsh A, Kumar S, Zakaria R, Millward CP, Mills SJ, Brodbelt AR, Jenkinson MD. Tranexamic acid use in meningioma surgery - A systematic review and meta-analysis. J Clin Neurosci 2023; 110:53-60. [PMID: 36796271 DOI: 10.1016/j.jocn.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and registered in PROSPERO (CRD42021292157). Six databases were searched up to November 2021 for phase 2-4 control trials or cohort studies, in the English language, examining TXA use during meningioma surgery. Studies ran outside of dedicated neurosurgical departments or centres were excluded. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random effects meta-analysis were performed to delineate differences in operative and postoperative outcomes. Four studies (281 patients) were included. TXA use significantly reduced intraoperative blood loss (mean difference 315.7 mls [95% confidence interval [CI] -532.8, -98.5]). Factors not affected by TXA use were transfusion requirement (odds ratio = 0.52; 95% CI 0.27, 0.98), operation time (mean difference = -0.2 h; 95% CI -0.8, 0.4), postoperative seizures (Odds Ratio [OR] = 0.88; 95% CI 0.31, 2.53), hospital stay (mean difference = -1.2; 95% CI -3.4, 0.9) and disability after surgery (OR = 0.50; 95% CI 0.23, 1.06). The key limitations of this review were the small sample size, limited data for secondary outcomes and a lack of standardised method for measuring blood loss. TXA use reduces blood loss in meningioma surgery, but not transfusion requirement or postoperative complications. Larger trials are required to investigate the impact of TXA on patient-reported postoperative outcomes.
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Affiliation(s)
- Abigail L Clynch
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK.
| | - Conor S Gillespie
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - George E Richardson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Ali Bakhsh
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Siddhant Kumar
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rasheed Zakaria
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Chowdhury D. To Assess the Outcomes Associated With the Use of Tranexamic Acid in the Open Fixation of Pelvic and Acetabular Fractures. Cureus 2023; 15:e38232. [PMID: 37261178 PMCID: PMC10226826 DOI: 10.7759/cureus.38232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
There is a growing knowledge base for the use of antifibrinolytic therapy in trauma and orthopaedic surgery. The mechanism of action of tranexamic acid (TXA) is through the inhibition of fibrinolysis. The role of TXA in hip fractures has been researched extensively. However, the research has been limited to the cases of pelvic and acetabular fractures. This systematic review aimed to examine the effect of TXA on patients undergoing open pelvic and acetabular fracture surgery. The primary goal of the study was to examine the estimated blood loss (EBL) and blood transfusion rates in patients who received TXA versus those who did not receive TXA. The secondary goal was to examine the rates of deep venous thrombosis (DVT). A literature search was carried out using PubMed, Medline and the Cochrane database. The selection criteria for the systematic review were studies investigating intravenous TXA in the form of randomised controlled trials (RCTs), as well as cohort studies. Five studies were included in the systematic review with 625 total patients. The EBL between the two groups was noted to be 661 mL in the control group and 850 mL in the TXA (p=0.49). There was a marginally lower number of units transfused in the control group vs the TXA group (1.9 vs 2.2) (p=0.27). The rates of transfusion in the TXA group were 29% TXA whilst, in the control group, it was 31% (p=0.13). The overall incidence of DVT was 2.8% in the TXA group and 1.7% in the control group (p=0.097).
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Affiliation(s)
- Debkumar Chowdhury
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, GBR
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Hof L, Choorapoikayil S, Meybohm P, Zacharowski K. Is a Patient Blood Management programme economically reasonable? Curr Opin Anaesthesiol 2023; 36:228-233. [PMID: 36728724 DOI: 10.1097/aco.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The value of healthcare is defined as the achieved health outcome in relation to the incurred costs. Patient Blood Management (PBM) is a multidisciplinary, evidence-based and patient-centred concept to optimize the patients' red blood cell mass, minimize blood loss and bleeding and to secure the physiological reserve, including the promotion of evidence-based transfusion strategies. This review describes the healthcare value and the cost effectiveness of single PBM measures as well as the implementation of comprehensive PBM programmes. RECENT FINDINGS Overall, measures improving surgical outcome and reducing hospital length of stay, such as intravenous iron supplementation in iron deficient anaemic patients, the use of antifibrinolytic agents for the treatment of bleeding, the use of cell salvage and adherence to an evidence-based transfusion strategy, are associated with cost savings. SUMMARY Although several single PBM measures have been shown to be effective and cost-efficient, it remains challenging to compare the results among differing healthcare systems.
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Affiliation(s)
- Lotta Hof
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt
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